Kenneth Leon Gortz, O.D.
Individual provider Active NPI Optometrist · Willard, OH
NPI 1295973154 · NPPES record last updated Aug 18, 2016
Key facts
- NPI
- 1295973154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2891 (OH)
- Practice address
- 421A E Walton St
Willard, OH 44890-9108 - Phone
- (419) 933-4327
- Fax
- (419) 933-4336
- NPI assigned
- Jan 30, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2891 | OH | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ohio Hearing Professionals, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2891 | OH | Yes |
Addresses
Primary practice location
421A E Walton St
Willard, OH 44890-9108
Mailing address
1500 S County Road 1
Tiffin, OH 44883-9746
Phone (419) 443-0710
Other providers in Willard, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.