Provider Demographics
NPI:1013027390
Name:KOHTZ, JANET ELIZABETH (OD)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:ELIZABETH
Last Name:KOHTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 INDIANA AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4290
Mailing Address - Country:US
Mailing Address - Phone:951-682-1600
Mailing Address - Fax:951-682-1680
Practice Address - Street 1:6700 INDIANA AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4290
Practice Address - Country:US
Practice Address - Phone:951-682-1600
Practice Address - Fax:951-682-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4883TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0569760001OtherCIGNA MEDICARE
P00316151OtherRAILROAD MEDICARE
CASD0048830Medicaid
CAGSD000520Medicaid
CAGSD000520Medicaid
CASD0048830Medicare PIN