Provider Demographics
NPI:1750457719
Name:KLOTZ, RICHARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:KLOTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18800 MAIN ST
Mailing Address - Street 2:101
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1707
Mailing Address - Country:US
Mailing Address - Phone:714-847-5900
Mailing Address - Fax:714-842-4590
Practice Address - Street 1:18800 MAIN ST
Practice Address - Street 2:101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1707
Practice Address - Country:US
Practice Address - Phone:714-847-5900
Practice Address - Fax:714-842-4590
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG17244207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAK9274983OtherBNDD
CAAK9274983OtherBNDD
CA1750457719Medicare NSC