Healthcare Provider Details

I. General information

NPI: 1962931519
Provider Name (Legal Business Name): ERIK KUNTZSCH OD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DR
BLUE ASH OH
45242-5664
US

IV. Provider business mailing address

6507 HARRISON AVE UNIT E
CINCINNATI OH
45247-2815
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax:
Mailing address:
  • Phone: 518-312-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: