Provider Demographics
NPI:1154400950
Name:KULBERSH, WILLIAM IRA
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:IRA
Last Name:KULBERSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 PEACHTREE ST NE
Mailing Address - Street 2:UNIT 916
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3936
Mailing Address - Country:US
Mailing Address - Phone:404-423-6666
Mailing Address - Fax:
Practice Address - Street 1:943 PEACHTREE ST NE
Practice Address - Street 2:UNIT 916
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3936
Practice Address - Country:US
Practice Address - Phone:404-423-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist