MEDICARE: RICHARD L KAUTZMAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18001906B	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00948130	OTHER	IN	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407845928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L KAUTZMAN OD

Provider Business Mailing Address
First Line	:	7250 CLEARVISTA DR
Second Line	:	SUITE 180
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4692
Country	:	US
Telephone Number	:	317-356-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 CLEARVISTA DR
Second Line	:	SUITE180
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4692
Country	:	US
Telephone Number	:	317-356-1500
Fax Number	:	317-357-5383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	11/17/2020

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