Provider Demographics
NPI:1033269485
Name:DUTTON, RONALD W (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:DUTTON
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 1:1601 E BASIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-4611
Mailing Address - Country:US
Mailing Address - Phone:775-751-1791
Mailing Address - Fax:775-751-3991
Practice Address - Street 1:1601 E BASIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-4611
Practice Address - Country:US
Practice Address - Phone:775-751-1791
Practice Address - Fax:775-751-3991
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002502026Medicaid
NVV34247Medicare PIN
NVCC1738OtherBCBS PROVIDER ID
NV4422060001Medicare NSC
NVT67195Medicare UPIN
NV410049319OtherRAILROAD MEDICARE