Phillip George Koultourides, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003080 Issued in IN

Practice address

2400 Morthland Dr
Valparaiso, IN 46383

Phone

(219) 465-2788

Fax

(219) 465-2785

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Phillip G Koultourides, O.D. P.C.

  • Optometrist
  • Schererville, IN
  • NPI 1316567134
  NPD (past) Authorized official
• Phillip G. Koultourides, O.D. P.C.

  • Optometrist
  • Valparaiso, IN
  • NPI 1508192147
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1295847986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 DRAKE DR",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739066",
            "telephone_number": "219-365-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MORTHLAND DR",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "46383",
            "telephone_number": "219-465-2788",
            "fax_number": "219-465-2785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 Indianapolis Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Schererville",
            "state": "IN",
            "postal_code": "463751206",
            "country_code": "US",
            "telephone_number": "219-322-3819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOULTOURIDES",
        "first_name": "PHILLIP",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Kopp, PHARMD.
• Asha Koshy, APN
• John Nick Kostidis, D.C.
• Daniel Richard Kotfer, MD
• Anil Kothari, M.D.
• Lauren Hansen Koveck, DDS
• Rory Kramer
• Amy Jean Kreft, RN, FNP-BC
• Luana S. Krieger-Blake, MSW, LCSW
• Sandra L. Kritenbrink, MSW, LCSW

• Optometrist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.