Provider Demographics
NPI:1497997902
Name:KALUZNE, STEPHEN PATRICK
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:KALUZNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ASHLEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2917
Mailing Address - Country:US
Mailing Address - Phone:336-774-1770
Mailing Address - Fax:
Practice Address - Street 1:1330 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2917
Practice Address - Country:US
Practice Address - Phone:336-774-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist