Provider Demographics
NPI:1790778918
Name:KUNTZ, CRAIG L (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:KUNTZ
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 1:2610 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-8436
Mailing Address - Country:US
Mailing Address - Phone:480-892-8400
Mailing Address - Fax:480-892-1889
Practice Address - Street 1:270 S CANDY LN
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4164
Practice Address - Country:US
Practice Address - Phone:928-634-4202
Practice Address - Fax:928-634-5963
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV337152W00000X
AZ1885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ787200Medicaid
NV102286Medicare PIN