Provider Demographics
NPI:1134299381
Name:CRUTE, RICHARD A (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:CRUTE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2716
Mailing Address - Country:US
Mailing Address - Phone:401-732-1180
Mailing Address - Fax:
Practice Address - Street 1:566 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2716
Practice Address - Country:US
Practice Address - Phone:401-732-1180
Practice Address - Fax:401-738-3249
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP00096156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009881Medicaid
RI0426970001Medicare NSC