Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 6309T | TX |
NPI | 1124274972 |
---|---|
Provider Name | Dr. Kristen Kautzman |
First Address | San Antonio, TX 78216-7763 |
Second Address | San Antonio, TX 78216-2048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 12/08/2008 |