Provider Demographics
NPI:1336322056
Name:TUTTLE, JOEL R (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:TUTTLE
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 1:2715 WILLETTA ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3471
Mailing Address - Country:US
Mailing Address - Phone:541-926-5848
Mailing Address - Fax:541-926-2873
Practice Address - Street 1:2715 WILLETTA ST SW STE B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3471
Practice Address - Country:US
Practice Address - Phone:541-926-5848
Practice Address - Fax:541-926-2873
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3430ATI152W00000X
IA002407152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Yes152W00000XEye and Vision Services ProvidersOptometrist