MEDICARE: ERIC J STOLTZ O.D.

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	1908DT	KY

General Provider Information

NPI Number	:	1750637435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC J STOLTZ O.D.

Provider Business Mailing Address
First Line	:	1195 BARRETT BLVD
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-7508
Country	:	US
Telephone Number	:	270-844-8090
Fax Number	:	270-831-8676

Provider Business Practice Location Address
First Line	:	1195 BARRETT BLVD
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-7508
Country	:	US
Telephone Number	:	270-844-8090
Fax Number	:	270-831-8676

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

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/05/2016

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