Individual
DR. PHILLIP GEORGE KOULTOURIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2400 MORTHLAND DR, VALPARAISO, IN 46383
(219) 465-2788
(219) 465-2785
Mailing address
9140 DRAKE DR, SAINT JOHN, IN 46373-9066
(219) 365-8069
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003080
IN
Other
Enumeration date
08/31/2006
Last updated
09/09/2022
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