Provider Demographics
NPI:1306822663
Name:TUTTLE, RONALD GRAY (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:GRAY
Last Name:TUTTLE
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 1:631 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5310
Mailing Address - Country:US
Mailing Address - Phone:336-723-1041
Mailing Address - Fax:336-773-0086
Practice Address - Street 1:631 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5310
Practice Address - Country:US
Practice Address - Phone:336-723-1041
Practice Address - Fax:336-773-0086
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC642156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician