Provider Demographics
NPI:1285784397
Name:KUTCH, ELZA LEROY (OD)
Entity type:Individual
Prefix:
First Name:ELZA
Middle Name:LEROY
Last Name:KUTCH
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 334
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836
Mailing Address - Country:US
Mailing Address - Phone:979-567-3420
Mailing Address - Fax:
Practice Address - Street 1:3431 COUNTY RD 330
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836
Practice Address - Country:US
Practice Address - Phone:979-567-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist