Provider Demographics
NPI:1891894283
Name:RICHARD S. HUTTO, O.D. PA
Entity Type:Organization
Organization Name:RICHARD S. HUTTO, O.D. PA
Other - Org Name:TEXAS STATE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-421-1243
Mailing Address - Street 1:6956 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9646
Mailing Address - Country:US
Mailing Address - Phone:281-421-1243
Mailing Address - Fax:281-421-7262
Practice Address - Street 1:6956 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9646
Practice Address - Country:US
Practice Address - Phone:281-421-1243
Practice Address - Fax:281-421-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1979TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01979TGOtherOPTOMETRY LICENSE
TX0010FHOtherBCBS OF TEXAS
TX14849902Medicaid
TX1114149259Medicare NSC
TX0010FHOtherBCBS OF TEXAS
TXT13984Medicare UPIN
TX4362730001Medicare NSC