Provider Demographics
NPI:1073525069
Name:JASON D MUNITZ OD & SCOTT RUTKOSKI OD PTR
Entity Type:Organization
Organization Name:JASON D MUNITZ OD & SCOTT RUTKOSKI OD PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUTKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-297-2970
Mailing Address - Street 1:547 CANTON STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947
Mailing Address - Country:US
Mailing Address - Phone:570-297-2970
Mailing Address - Fax:570-297-5057
Practice Address - Street 1:547 CANTON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947
Practice Address - Country:US
Practice Address - Phone:570-297-2970
Practice Address - Fax:570-297-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000806152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU57463Medicare UPIN