Provider Demographics
NPI:1285676361
Name:FOUTZ, PAUL M (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:FOUTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1306 E SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7578
Mailing Address - Country:US
Mailing Address - Phone:970-245-5678
Mailing Address - Fax:970-245-5679
Practice Address - Street 1:1306 E SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7578
Practice Address - Country:US
Practice Address - Phone:970-245-5678
Practice Address - Fax:970-245-5679
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU92933Medicare UPIN
C476448Medicare PIN