Provider Demographics
NPI:1952574295
Name:SHAWN M KURTZ OD PLLC
Entity Type:Organization
Organization Name:SHAWN M KURTZ OD PLLC
Other - Org Name:RETROSPECS EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGIBG MEMEBR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-576-4292
Mailing Address - Street 1:208 S 72ND AVE STE 100
Mailing Address - Street 2:
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 STE 100
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028132Medicaid
WA2028132Medicaid
WA4972510001Medicare NSC