NPI 1114192044

Mark F. Kapusta O.D. INC

Organisation Optometrist Willoughby, OH

Practice location

Address: 30851 Euclid Ave Suite 4, Willoughby, OH 44094-3198
Phone: (440) 944-5155
Fax: (440) 943-9460

Authorised official

Name: Nicole Renae McCallion
Title: Medical Secretary
Phone: (440) 944-5155

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 3511T508 (OH)

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Registry record

NPI: 1114192044
Entity type: Organization
NPI issued: 22 Apr 2008
Record last updated: 22 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.