Provider Demographics
NPI:1417156662
Name:TUTTLE, HEATHER ANNE NOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANNE NOEL
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8369 ALLEGHENY GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-8240
Mailing Address - Country:US
Mailing Address - Phone:605-695-1256
Mailing Address - Fax:952-442-2070
Practice Address - Street 1:753 MARKETPLACE DRIVE
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387
Practice Address - Country:US
Practice Address - Phone:952-442-2015
Practice Address - Fax:952-442-2070
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3092152W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1417156662Medicaid
410003699Medicare PIN