Healthcare Provider Details

I. General information

NPI: 1518087493
Provider Name (Legal Business Name): THOMAS S. GUTZWILLER OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 GLENWAY AVE
CINCINNATI OH
45238-2040
US

IV. Provider business mailing address

5979 GLENWAY AVE
CINCINNATI OH
45238-2040
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-3515
  • Fax:
Mailing address:
  • Phone: 513-922-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2535-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: