Provider Demographics
NPI:1558642769
Name:KUNZ, THOMAS JACOB (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JACOB
Last Name:KUNZ
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-0819
Mailing Address - Country:US
Mailing Address - Phone:575-526-3314
Mailing Address - Fax:575-526-1061
Practice Address - Street 1:330 E BOUTZ RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3255
Practice Address - Country:US
Practice Address - Phone:575-526-3314
Practice Address - Fax:575-526-1061
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM629152W00000X
IDODP-100313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist