Provider Demographics
NPI:1598926024
Name:SUTCLIFFE, RUSEL MILLER (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSEL
Middle Name:MILLER
Last Name:SUTCLIFFE
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 1:1620 N US HIGHWAY 1
Mailing Address - Street 2:ONE
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3228
Mailing Address - Country:US
Mailing Address - Phone:561-746-4000
Mailing Address - Fax:561-746-3885
Practice Address - Street 1:1620 N US HIGHWAY 1
Practice Address - Street 2:ONE
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3228
Practice Address - Country:US
Practice Address - Phone:561-746-4000
Practice Address - Fax:561-746-3885
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC601152W00000X
FLOPC 601152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management