Provider Demographics
NPI:1689166803
Name:KALOTA, DAVID MARK (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:KALOTA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 BUFFALO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4299
Mailing Address - Country:US
Mailing Address - Phone:716-283-8746
Mailing Address - Fax:716-283-1873
Practice Address - Street 1:7900 BUFFALO AVE STE A
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4299
Practice Address - Country:US
Practice Address - Phone:716-283-8746
Practice Address - Fax:716-283-1873
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004425156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician