Provider Demographics
NPI:1114137841
Name:RUTZEN EYE SPECIALISTS
Entity Type:Organization
Organization Name:RUTZEN EYE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:RUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-975-0090
Mailing Address - Street 1:489 RITCHIE HIGHWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2910
Mailing Address - Country:US
Mailing Address - Phone:410-975-0090
Mailing Address - Fax:410-975-0089
Practice Address - Street 1:489 RITCHIE HIGHWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2910
Practice Address - Country:US
Practice Address - Phone:410-975-0090
Practice Address - Fax:410-975-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051102207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty