Provider Demographics
NPI:1992808703
Name:STEPHEN J. KALUZNE, O.D.,PA
Entity type:Organization
Organization Name:STEPHEN J. KALUZNE, O.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALUZNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-774-1770
Mailing Address - Street 1:1330 ASHLEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2917
Mailing Address - Country:US
Mailing Address - Phone:336-774-1770
Mailing Address - Fax:336-774-1130
Practice Address - Street 1:1330 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2917
Practice Address - Country:US
Practice Address - Phone:336-774-1770
Practice Address - Fax:336-774-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0978460001Medicare NSC
NC2336309Medicare PIN
246272FMedicare PIN