Provider Demographics
NPI:1437486644
Name:HEATHER A TUTTLE
Entity Type:Organization
Organization Name:HEATHER A TUTTLE
Other - Org Name:HEATHER TUTTLE, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-405-9850
Mailing Address - Street 1:8360 KIMBALL DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2129
Mailing Address - Country:US
Mailing Address - Phone:952-405-9850
Mailing Address - Fax:
Practice Address - Street 1:810 COUNTY ROAD 42 W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4426
Practice Address - Country:US
Practice Address - Phone:952-435-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty