Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT4883TPA | CA |
NPI | 1013027390 |
---|---|
Provider Name | Ms. Janet Elizabeth Kohtz |
First Address | Riverside, CA 92506-4290 |
Second Address | Riverside, CA 92506-4290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 23/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0569760001 | CIGNA MEDICARE (01) | |
GSD000520 | (05) | CA |
P00316151 | RAILROAD MEDICARE (01) | |
SD0048830 | (05) | CA |
T09808 | (02) | CA |