Provider Demographics
NPI:1790899847
Name:KWIATKOWSKI, DENNIS THADDEUS (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:THADDEUS
Last Name:KWIATKOWSKI
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 1:2370 YORK RD
Mailing Address - Street 2:BLDG E-3
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1031
Mailing Address - Country:US
Mailing Address - Phone:215-343-5524
Mailing Address - Fax:215-343-6439
Practice Address - Street 1:2370 YORK RD
Practice Address - Street 2:BLDG E-3
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1031
Practice Address - Country:US
Practice Address - Phone:215-343-5524
Practice Address - Fax:215-343-6439
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000183152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36056OtherDAVIS VISION
JE13853OtherSPECTERA VISION
112504OtherEYEMED VISION PLAN
OEG000183OtherVISION BENEFITS OF AMERIC
PA01618352Medicaid
112504OtherCOLE MANAGED VISION PLAN
0055308OtherAETNA HMO
4404599OtherAETNA PPO
0023534000OtherBS & KEYSTONE EAST
396250OtherNATIONAL VISION ADMINISTR
JE13853OtherSPECTERA VISION
PA428444Medicare PIN