Provider Demographics
NPI:1649388679
Name:KUCZYNSKI, ROBERT B (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:KUCZYNSKI
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 1:221 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1748
Mailing Address - Country:US
Mailing Address - Phone:610-566-3658
Mailing Address - Fax:
Practice Address - Street 1:407 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2521
Practice Address - Country:US
Practice Address - Phone:610-363-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29277Medicare UPIN