Healthcare Provider Details

I. General information

NPI: 1023634847
Provider Name (Legal Business Name): ESTHER LAUTZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SMITH RD
NORWOOD OH
45212-2793
US

IV. Provider business mailing address

4600 SMITH RD
NORWOOD OH
45212-2793
US

V. Phone/Fax

Practice location:
  • Phone: 513-631-8889
  • Fax:
Mailing address:
  • Phone: 513-631-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: