Provider Demographics
NPI:1902034077
Name:TUTTLE, NATHAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-3937
Mailing Address - Fax:314-362-3725
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DEPT OPHTHALMOLOGY, 6TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-3937
Practice Address - Fax:314-362-3725
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2009017108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317061208Medicaid
MO1902034077Medicaid