Provider Demographics
NPI:1982749909
Name:KASZA, CLINT L (OD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:L
Last Name:KASZA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1575 SPACE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-2441
Mailing Address - Country:US
Mailing Address - Phone:719-573-2011
Mailing Address - Fax:719-597-9491
Practice Address - Street 1:VISION CENTER AT WAL-MART
Practice Address - Street 2:1575 SPACE CENTER DRIVE
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915
Practice Address - Country:US
Practice Address - Phone:719-573-2011
Practice Address - Fax:719-597-9491
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist