Provider Demographics
NPI:1912981036
Name:TUTTLE, STEVEN ORLAND (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ORLAND
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 EAST MAIN STREET
Mailing Address - Street 2:P.O. BOX 785
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513
Mailing Address - Country:US
Mailing Address - Phone:435-381-2040
Mailing Address - Fax:435-381-2475
Practice Address - Street 1:190 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513
Practice Address - Country:US
Practice Address - Phone:435-381-2040
Practice Address - Fax:435-381-2475
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114028-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005768701Medicare ID - Type Unspecified
UTT95882Medicare UPIN