Provider Demographics
NPI:1598745671
Name:WORTZ, ALLAN D (OD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:D
Last Name:WORTZ
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 1:1455 MONTREAL ST SE
Mailing Address - Street 2:PO BOX 699
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-0699
Mailing Address - Country:US
Mailing Address - Phone:320-587-6308
Mailing Address - Fax:866-203-6862
Practice Address - Street 1:1455 MONTREAL ST SE
Practice Address - Street 2:
Practice Address - City:HUTCHISON
Practice Address - State:MN
Practice Address - Zip Code:55350-0699
Practice Address - Country:US
Practice Address - Phone:320-587-6308
Practice Address - Fax:866-203-6862
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN752225800Medicaid
U44527Medicare UPIN
MNC06935Medicare PIN