Healthcare Provider Details

I. General information

NPI: 1790778918
Provider Name (Legal Business Name): CRAIG L KUNTZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S CANDY LN
COTTONWOOD AZ
86326-4164
US

IV. Provider business mailing address

2610 E UNIVERSITY DR
MESA AZ
85213-8436
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-4202
  • Fax: 928-634-5963
Mailing address:
  • Phone: 480-892-8400
  • Fax: 480-892-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number337
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: