Provider Demographics
NPI:1427523547
Name:KAUDEWITZ, JOHN REINHART (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:REINHART
Last Name:KAUDEWITZ
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 1:312 E MAIN ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5733
Mailing Address - Country:US
Mailing Address - Phone:423-407-3311
Mailing Address - Fax:423-707-2299
Practice Address - Street 1:312 E MAIN ST UNIT 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5733
Practice Address - Country:US
Practice Address - Phone:423-407-3311
Practice Address - Fax:423-707-2299
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT3732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist