Provider Demographics
NPI:1255424545
Name:JAMES P. TUTTLE, OD
Entity type:Organization
Organization Name:JAMES P. TUTTLE, OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-266-5661
Mailing Address - Street 1:234 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1023
Mailing Address - Country:US
Mailing Address - Phone:717-266-5661
Mailing Address - Fax:717-266-6510
Practice Address - Street 1:234 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1023
Practice Address - Country:US
Practice Address - Phone:717-266-5661
Practice Address - Fax:717-266-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02666500OtherCAPITAL BLUECROSS
PAWH1741132OtherHIGHMARK
PA50497OtherDAVIS VISION
PA0742650001Medicare NSC
PA062680Medicare PIN