Provider Demographics
NPI:1245594423
Name:KULICH, DAVID B (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:KULICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SAW MILL LN
Mailing Address - Street 2:APT 12B
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1925
Mailing Address - Country:US
Mailing Address - Phone:570-573-3732
Mailing Address - Fax:
Practice Address - Street 1:925 HORSHAM RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1210
Practice Address - Country:US
Practice Address - Phone:570-573-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist