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NPI Code Detail

MEDICARE: DR. GARY ALLEN KITZROW O.D.

MEDICARE: DR. GARY ALLEN KITZROW O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2339TOR

General Provider Information

NPI Number : 1245427939
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY ALLEN KITZROW O.D.
Provider Business Mailing Address
First Line : 2051 NEWMARK AVE
Second Line :
City : COOS BAY
State : OR
Zip : 97420-4728
Country : US
Telephone Number : 541-888-4849
Fax Number : 541-888-0309
Provider Business Practice Location Address
First Line : 2051 NEWMARK AVE
Second Line :
City : COOS BAY
State : OR
Zip : 97420-4728
Country : US
Telephone Number : 541-888-4849
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2007
Last Update Date : 05/07/2010

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