Provider Demographics
NPI:1407845928
Name:KAUTZMAN, RICHARD L (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:KAUTZMAN
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 1:7250 CLEARVISTA DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4692
Mailing Address - Country:US
Mailing Address - Phone:317-356-1500
Mailing Address - Fax:
Practice Address - Street 1:7250 CLEARVISTA DR
Practice Address - Street 2:SUITE180
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4692
Practice Address - Country:US
Practice Address - Phone:317-356-1500
Practice Address - Fax:317-357-5383
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001906B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100172540Medicaid
INP00948130OtherMEDICARE ID
INU94090Medicare UPIN
INP00948130OtherMEDICARE ID