Provider Demographics
NPI:1841286465
Name:KAVCSAK, NICHOLAS MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:KAVCSAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1512
Mailing Address - Country:US
Mailing Address - Phone:908-475-5757
Mailing Address - Fax:
Practice Address - Street 1:416 FRONT ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1512
Practice Address - Country:US
Practice Address - Phone:908-475-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4142/TO 00091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1D2216809Medicaid
NJ488992OtherAETNA
NJ071306B1LOtherMEDICARE BILLING NO.
NJ7061030OtherCIGNA
NJ222426325OtherBLUE CROSS BLUE SHIELD
NJKA71306Medicare ID - Type Unspecified
NJ7061030OtherCIGNA
NJ1D2216809Medicaid