Healthcare Provider Details

I. General information

NPI: 1952574295
Provider Name (Legal Business Name): SHAWN M KURTZ OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S 72ND AVE STE 100
YAKIMA WA
98908-1600
US

IV. Provider business mailing address

208 S 72ND AVE STE 100
YAKIMA WA
98908-1600
US

V. Phone/Fax

Practice location:
  • Phone: 509-576-4292
  • Fax: 509-966-3303
Mailing address:
  • Phone: 509-576-4292
  • Fax: 509-966-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SHAWN M KURTZ
Title or Position: MANAGIBG MEMEBR
Credential: OD
Phone: 509-576-4292