Provider Demographics
NPI:1750637435
Name:STOLTZ, ERIC J (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:STOLTZ
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 1:1195 BARRETT BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-7508
Mailing Address - Country:US
Mailing Address - Phone:270-844-8090
Mailing Address - Fax:270-831-8676
Practice Address - Street 1:1195 BARRETT BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-7508
Practice Address - Country:US
Practice Address - Phone:270-844-8090
Practice Address - Fax:270-831-8676
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1908DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist