Provider Demographics
NPI:1982702023
Name:CUTLER, JAMES JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:CUTLER
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 1:1637 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1732
Mailing Address - Country:US
Mailing Address - Phone:909-982-0100
Mailing Address - Fax:909-985-1552
Practice Address - Street 1:1637 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1732
Practice Address - Country:US
Practice Address - Phone:909-982-0100
Practice Address - Fax:909-985-1552
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9229T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
93-1118263OtherFEDERAL TAX ID #
CASD0092290Medicaid
CA399-5653-7OtherSTATE ID #
CASD0922900Medicare PIN
CAU13928Medicare UPIN
CA5319900001Medicare NSC