Provider Demographics
NPI:1184952434
Name:KKORALEWSKI LLC
Entity type:Organization
Organization Name:KKORALEWSKI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:KORALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-795-0336
Mailing Address - Street 1:2605 E MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5319
Mailing Address - Country:US
Mailing Address - Phone:520-795-0336
Mailing Address - Fax:520-327-5144
Practice Address - Street 1:2605 E MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5319
Practice Address - Country:US
Practice Address - Phone:520-795-0336
Practice Address - Fax:520-327-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ134279OtherPTAN
AZZ134279OtherPTAN