Provider Demographics
NPI:1649368713
Name:CERUTTI, DANIEL DAVID (OD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DAVID
Last Name:CERUTTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10336 TOPAZ SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6270
Mailing Address - Country:US
Mailing Address - Phone:314-638-4123
Mailing Address - Fax:314-961-1735
Practice Address - Street 1:9973 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1915
Practice Address - Country:US
Practice Address - Phone:314-961-3151
Practice Address - Fax:314-961-1735
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT38792Medicare UPIN