Provider Demographics
NPI:1871943449
Name:KUZNIAR, JAMIE L (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:KUZNIAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:MUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:598 SNOWMASS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1377
Mailing Address - Country:US
Mailing Address - Phone:989-284-7321
Mailing Address - Fax:
Practice Address - Street 1:4114 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48301-3000
Practice Address - Country:US
Practice Address - Phone:248-539-4800
Practice Address - Fax:248-539-4894
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18003970A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201367560Medicaid
IN201367560Medicaid