Provider Demographics
NPI:1982922191
Name:KAUTZ, RONALD HERMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HERMAN
Last Name:KAUTZ
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:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-0996
Mailing Address - Country:US
Mailing Address - Phone:940-627-0996
Mailing Address - Fax:
Practice Address - Street 1:303 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1633
Practice Address - Country:US
Practice Address - Phone:940-627-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02668TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093014101Medicaid
TX093014101Medicaid