Provider Demographics
NPI:1518087493
Name:GUTZWILLER, THOMAS S (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:GUTZWILLER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2040
Mailing Address - Country:US
Mailing Address - Phone:513-922-3515
Mailing Address - Fax:
Practice Address - Street 1:5979 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2040
Practice Address - Country:US
Practice Address - Phone:513-922-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2535-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964309Medicaid