Active NPI
Dennis J Kautzman, O.D.
- Optometrist
- Fort Gratiot, MI
National Provider Identifier
1023171857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002310
- Practice address
- 4460 24TH Ave
Fort Gratiot, MI 48059-3809 - Phone
- (810) 385-9638
- Fax
- (810) 385-8105
- NPI assigned
- Dec 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002310 | MI | Primary |
Addresses
Primary practice location
4460 24TH Ave
Fort Gratiot, MI 48059-3809
Mailing address
3121 E Village LN
Port Huron, MI 48060-1404
Phone (810) 385-8152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002310 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023171857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3121 E VILLAGE LN",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480601404",
"telephone_number": "810-385-8152",
"fax_number": "810-385-9638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4460 24TH AVE",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480593809",
"telephone_number": "810-385-9638",
"fax_number": "810-385-8105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAUTZMAN",
"first_name": "DENNIS",
"middle_name": "J",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gratiot, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.