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Individual

BENJAMIN TAUTGES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
44139 MONTEREY AVE STE A, PALM DESERT, CA 92260
(760) 779-0800
(760) 779-0801
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(626) 269-5371
(626) 269-2100

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
2237
AZ
152W00000X
Optometrist
Primary
33945
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1760541569
CA
Enumeration date
05/07/2018
Last updated
08/07/2018
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