Basic Information
| Provider Information | |||||||||
| NPI: | 1427403104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUTA | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33541 AURORA RD | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441393705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402482020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33541 AURORA RD | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441393705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402482020 | ||||||||
| FaxNumber: | 4402483425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 6473 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.