Provider Demographics
NPI:1093295305
Name:RUTKOWSKI, CLAYTON WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:WILLIAM
Last Name:RUTKOWSKI
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 1:5401 E. PARMER LANE
Mailing Address - Street 2:APT 5332
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 HWY 290 E
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2018
Practice Address - Country:US
Practice Address - Phone:512-285-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9376T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist