Provider Demographics
NPI:1609924968
Name:MICHAEL D KLAUTZSCH, OD, PC
Entity Type:Organization
Organization Name:MICHAEL D KLAUTZSCH, OD, PC
Other - Org Name:ALL FAMILY VISION CARE, SALEM VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL PROJECTS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-757-8844
Mailing Address - Street 1:1597 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2630
Mailing Address - Country:US
Mailing Address - Phone:541-757-8844
Mailing Address - Fax:541-754-9810
Practice Address - Street 1:1597 SW 53RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2630
Practice Address - Country:US
Practice Address - Phone:541-757-8844
Practice Address - Fax:541-754-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR2515ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079327001OtherBLUE CROSS
OR074950Medicaid
OR4115630001Medicare NSC
OR074950Medicaid
ORR104768Medicare PIN