Individual
GRANT C AMSTUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
31 BOBBY BLAND WAY, LEITCHFIELD, KY 42754-1744
(270) 259-0500
(270) 259-0079
Mailing address
31 BOBBY BLAND WAY, LEITCHFIELD, KY 42754-1744
(270) 259-0500
(270) 259-0079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003059A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200917980
—
IN
01
—
248880
MEDICARE ID
IN
Enumeration date
08/19/2005
Last updated
10/02/2023
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