Provider Demographics
NPI:1972740421
Name:KARL F. KUTCH, O.D., P.C.
Entity Type:Organization
Organization Name:KARL F. KUTCH, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-288-4427
Mailing Address - Street 1:1128 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-7415
Mailing Address - Country:US
Mailing Address - Phone:972-288-4427
Mailing Address - Fax:
Practice Address - Street 1:1128 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7415
Practice Address - Country:US
Practice Address - Phone:972-288-4427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0930398-01Medicaid
TX94169OtherUNITED HEALTH CARE
TX00E06JOtherBLUE CROSS BLUE SHIELD
TX0903400001Medicare NSC
TX0930398-01Medicaid