Provider Demographics
NPI:1447249727
Name:KWITNY, BRIAN JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFREY
Last Name:KWITNY
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 1:4631 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-3137
Mailing Address - Country:US
Mailing Address - Phone:317-545-1114
Mailing Address - Fax:
Practice Address - Street 1:2835 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-2147
Practice Address - Country:US
Practice Address - Phone:317-926-0283
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002256A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U372071Medicare UPIN