Provider Demographics
NPI:1700875895
Name:KURTZ, SHAWN M (OD PLLC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:M
Last Name:KURTZ
Suffix:
Gender:M
Credentials:OD PLLC
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Mailing Address - Street 1:208 S 72ND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1600
Mailing Address - Country:US
Mailing Address - Phone:509-576-4292
Mailing Address - Fax:509-966-3303
Practice Address - Street 1:208 S 72ND AVE
Practice Address - Street 2:STE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1600
Practice Address - Country:US
Practice Address - Phone:509-576-4292
Practice Address - Fax:509-966-3303
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOD00001984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4972510001Medicare NSC