Provider Demographics
NPI:1275732281
Name:JUTTE, PHILIP R (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:JUTTE
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 1:8970 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3818
Mailing Address - Country:US
Mailing Address - Phone:513-522-0035
Mailing Address - Fax:513-522-3416
Practice Address - Street 1:8970 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3818
Practice Address - Country:US
Practice Address - Phone:513-522-0035
Practice Address - Fax:513-522-3416
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5724 T2638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
JU4219911OtherPTAN