Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 4901003171 | MI |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4901003171 | MI |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 4901003171 | MI |
N | 152WP0200X | Pediatric Optomitrist | 4901003171 | MI |
N | 152WV0400X | Optomitrist - Vision Therapist | 4901003171 | MI |
NPI | 1205112893 |
---|---|
Provider Name | Dr. Gary S Kots |
First Address | Pine Ridge, SD 57770-1201 |
Second Address | Rosebud, SD 57570-8502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 09/05/2019 |