Provider Demographics
NPI:1568022184
Name:KUCHERA, HALLIE (OD)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:KUCHERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 LISA DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5212
Mailing Address - Country:US
Mailing Address - Phone:319-296-5960
Mailing Address - Fax:
Practice Address - Street 1:2027 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-4405
Practice Address - Country:US
Practice Address - Phone:319-505-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist