Provider Demographics
NPI:1790759090
Name:RUTZ, DUANE P (OD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:P
Last Name:RUTZ
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-0549
Mailing Address - Country:US
Mailing Address - Phone:218-732-8535
Mailing Address - Fax:218-732-6957
Practice Address - Street 1:204 S ATLANTIC
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728
Practice Address - Country:US
Practice Address - Phone:218-843-2663
Practice Address - Fax:218-843-2665
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
63520MCOtherBCBS OF MN
MN553718500Medicaid
MN553718500Medicaid
T66079Medicare UPIN