Provider Demographics
NPI:1437151321
Name:KULESIA, DAVID J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:KULESIA
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 1:3038 NC HIGHWAY 127 S
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5404
Mailing Address - Country:US
Mailing Address - Phone:828-294-1010
Mailing Address - Fax:828-294-1013
Practice Address - Street 1:3038 NC HIGHWAY 127 S
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5404
Practice Address - Country:US
Practice Address - Phone:828-294-1010
Practice Address - Fax:828-294-1013
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093NWMedicaid
NC89093NWMedicaid
NC2473103Medicare PIN