Provider Demographics
NPI:1619052966
Name:KASPEREK, WALTER JOSEPH (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JOSEPH
Last Name:KASPEREK
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 STATE ROUTE 222
Mailing Address - Street 2:EYEWEAR PLUS
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1834
Mailing Address - Country:US
Mailing Address - Phone:607-756-4159
Mailing Address - Fax:607-758-7827
Practice Address - Street 1:1100 STATE ROUTE 222
Practice Address - Street 2:EYEWEAR PLUS
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1834
Practice Address - Country:US
Practice Address - Phone:607-756-4159
Practice Address - Fax:607-758-7827
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003538-1156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Not Answered332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0199670001Medicare ID - Type Unspecified