Provider Demographics
NPI:1174718340
Name:KASPRZAK, STEVE (OD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:KASPRZAK
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 1:1234 ABBOTT RD STE 13
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1944
Mailing Address - Country:US
Mailing Address - Phone:716-770-5970
Mailing Address - Fax:716-219-1176
Practice Address - Street 1:642 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-7853
Practice Address - Country:US
Practice Address - Phone:716-695-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1553-584T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03221170Medicaid