Provider Demographics
NPI:1881178234
Name:KUZMIC, KASAYLA FE (OD)
Entity type:Individual
Prefix:DR
First Name:KASAYLA
Middle Name:FE
Last Name:KUZMIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KASAYLA
Other - Middle Name:FE
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2572 GASTON AVENUE
Mailing Address - Street 2:APT 1533
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226
Mailing Address - Country:US
Mailing Address - Phone:734-731-5145
Mailing Address - Fax:
Practice Address - Street 1:1253 N RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9666
Practice Address - Country:US
Practice Address - Phone:734-731-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004130AB152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist