Provider Demographics
NPI:1568031847
Name:KUCHA, CAROLINE ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:KUCHA
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 1:5446 N KENT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1931 SHERIDAN BLVD UNIT S
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1300
Practice Address - Country:US
Practice Address - Phone:303-578-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist