Provider Demographics
NPI:1831159268
Name:LUTZ, STEVEN P (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:LUTZ
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 1:1565 EASTOVER PLACE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104
Mailing Address - Country:US
Mailing Address - Phone:734-769-2909
Mailing Address - Fax:734-929-4142
Practice Address - Street 1:1565 EASTOVER PLACE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-769-2909
Practice Address - Fax:734-929-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H16509OtherBLUE CROSS
MI4829010Medicaid
900H165090OtherBLUE SHIELD
900H165090OtherBLUE SHIELD
MIP10910001Medicare ID - Type Unspecified