Provider Demographics
NPI:1447481312
Name:KLUTTZ, NATHAN LAWRENCE (OD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:LAWRENCE
Last Name:KLUTTZ
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 1:2800 SW WANAMAKER RD
Mailing Address - Street 2:SUITE 192
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4293
Mailing Address - Country:US
Mailing Address - Phone:785-272-0707
Mailing Address - Fax:785-271-1512
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2332
Practice Address - Country:US
Practice Address - Phone:785-242-2020
Practice Address - Fax:785-242-2335
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist