Provider Demographics
NPI:1295728806
Name:KUTCH, KARL F (OD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:F
Last Name:KUTCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:KARL
Other - Middle Name:F
Other - Last Name:KUTCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
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:972-285-4240
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:972-285-4240
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2315TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
94169OtherUNITED HEALTH CARE
TX0930398-01Medicaid
5767109OtherAETNA
TX2853823OtherCIGNA
TX8F20870OtherBCBS
TX0930398-01Medicaid