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Organization

PHILLIP G. KOULTOURIDES, O.D. P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PHILLIP KOULTOURIDES O.D. (PRESIDENT)
(219) 365-8069
Entity
Organization

Contact information

Practice address
2400 MORTHLAND DR, VALPARAISO, IN 46383-8329
(219) 465-2788
(219) 465-2785
Mailing address
9140 DRAKE DR, SAINT JOHN, IN 46373-9066
(219) 365-8069
(219) 465-2785

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003080
IN

Other

Enumeration date
11/01/2009
Last updated
11/01/2009
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