Provider Demographics
NPI:1568432334
Name:KAUTZ, ROBERT WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:KAUTZ
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 1:111 S 24TH ST W STE 1
Mailing Address - Street 2:PO BOX 20316
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5659
Mailing Address - Country:US
Mailing Address - Phone:406-248-1676
Mailing Address - Fax:406-245-3543
Practice Address - Street 1:111 S 24TH ST W STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5659
Practice Address - Country:US
Practice Address - Phone:406-248-1676
Practice Address - Fax:440-624-5354
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT410036137OtherRR MEDICARE
MT1219700001OtherCIGNA MEDICARE
MT25971OtherBCBS MT
MT8999OtherBCBS FEDERAL
MT0480488Medicaid
MT25971OtherBLUE CHIP
MT25971OtherBCBS MT
MTU52820Medicare UPIN