Provider Demographics
NPI:1083686984
Name:MCCUTCHAN, HOWARD HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:HENRY
Last Name:MCCUTCHAN
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:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-0715
Mailing Address - Country:US
Mailing Address - Phone:712-755-3893
Mailing Address - Fax:712-755-7580
Practice Address - Street 1:2306 12TH ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2002
Practice Address - Country:US
Practice Address - Phone:712-755-3893
Practice Address - Fax:712-755-7580
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42107817600OtherNE MEDICAID
IA0032920Medicaid
IA03292OtherBLUE CROSS/ WELLMARK
IA421078176OtherCOMERCIAL INSURANCE
IA410015661OtherRAILROAD MEDICARE
IA410015661OtherRAILROAD MEDICARE
IA42107817600OtherNE MEDICAID
IAT00386Medicare UPIN