Healthcare Provider Details

I. General information

NPI: 1164601167
Provider Name (Legal Business Name): MICHAEL D KLAUTZSCH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 SW KNOLL AVE STE 102
BEND OR
97702-3154
US

IV. Provider business mailing address

1470 SW KNOLL AVE STE 102
BEND OR
97702-3154
US

V. Phone/Fax

Practice location:
  • Phone: 541-797-0295
  • Fax:
Mailing address:
  • Phone: 541-797-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2515ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: