Provider Demographics
NPI:1952334351
Name:TUTTLE, JAMES POLLECK
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:POLLECK
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2844
Mailing Address - Country:US
Mailing Address - Phone:717-755-6906
Mailing Address - Fax:717-840-4847
Practice Address - Street 1:2050 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2844
Practice Address - Country:US
Practice Address - Phone:717-755-6906
Practice Address - Fax:717-840-4847
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU18783Medicare UPIN
PA062680Medicare PIN
PA0742650003Medicare NSC