Healthcare Provider Details

I. General information

NPI: 1295728806
Provider Name (Legal Business Name): KARL F KUTCH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KARL F KUTCH OD

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 N GALLOWAY AVE
MESQUITE TX
75149-7415
US

IV. Provider business mailing address

1128 N GALLOWAY AVE
MESQUITE TX
75149-7415
US

V. Phone/Fax

Practice location:
  • Phone: 972-288-4427
  • Fax: 972-285-4240
Mailing address:
  • Phone: 972-288-4427
  • Fax: 972-285-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTX2315TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: