Provider Demographics
NPI:1134148778
Name:KOLTUN, JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:KOLTUN
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 1:7171 SITIO CABALLERO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2008
Mailing Address - Country:US
Mailing Address - Phone:760-448-6466
Mailing Address - Fax:
Practice Address - Street 1:7171 SITIO CABALLERO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-2008
Practice Address - Country:US
Practice Address - Phone:760-448-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13464 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist