Provider Demographics
NPI:1164533410
Name:MCALLEN RUTZ EYE CLINIC PA
Entity Type:Organization
Organization Name:MCALLEN RUTZ EYE CLINIC PA
Other - Org Name:MCALLEN RUTZ OPTOMETRY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-843-2663
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:204 SOUTH ATLANTIC
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728
Mailing Address - Country:US
Mailing Address - Phone:218-843-2663
Mailing Address - Fax:218-843-2665
Practice Address - Street 1:204 SOUTH ATLANTIC
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728
Practice Address - Country:US
Practice Address - Phone:218-843-2663
Practice Address - Fax:218-843-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63520MCOtherBCBS
MN63520MCOtherBCBS
MN5000850001Medicare NSC
ND5000850001Medicare NSC