Provider Demographics
NPI:1255467296
Name:LUTZ, BARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:LUTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 GRAVENSTEIN HWY N
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2810
Mailing Address - Country:US
Mailing Address - Phone:707-823-7891
Mailing Address - Fax:707-823-9632
Practice Address - Street 1:868 GRAVENSTEIN HWY N
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2810
Practice Address - Country:US
Practice Address - Phone:707-823-7891
Practice Address - Fax:707-823-9632
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4765T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist