Provider Demographics
NPI:1821076902
Name:TUTT, RONALD C (OD MS FAAO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:TUTT
Suffix:
Gender:M
Credentials:OD MS FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18618 PALOMA PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3587
Mailing Address - Country:US
Mailing Address - Phone:210-497-6845
Mailing Address - Fax:210-536-1359
Practice Address - Street 1:2507 KENNEDY CIRCLE BLDG 110
Practice Address - Street 2:USAFSAM/FECO
Practice Address - City:BROOKS CITY-BASE
Practice Address - State:TX
Practice Address - Zip Code:78235-5116
Practice Address - Country:US
Practice Address - Phone:210-536-4534
Practice Address - Fax:210-536-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4036152W00000X
NE973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist