Provider Demographics
NPI:1932119278
Name:KACZYNSKI, ELI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:
Last Name:KACZYNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 W FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3041
Mailing Address - Country:US
Mailing Address - Phone:509-783-3161
Mailing Address - Fax:509-783-3163
Practice Address - Street 1:2529 W FALLS AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3041
Practice Address - Country:US
Practice Address - Phone:509-783-3161
Practice Address - Fax:509-783-3163
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016765207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1364306Medicaid
WA0017179OtherST IND
WA0017179OtherST IND