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General NPI Number Information
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NPI Number | 1699767632
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Entity Type | Individual
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Provider Name | KENNETH DAVID BOLTZ O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 5775 PERIMETER DR STE 160
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City | DUBLIN
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State | OH
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Zip | 43017-3257
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Country | US
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Telephone | 614-763-5775
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Fax | 614-675-3338
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Provider Business Mailing Address
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Address Line | 5775 PERIMETER DR STE 160
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City | DUBLIN
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State | OH
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Zip | 43017-3257
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Country | US
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Telephone | 614-763-5775
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Fax | 614-675-3338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OH3782
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License Number State | OH
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