MEDICARE: STEVEN R. RUTAN, O.D., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033185897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN R. RUTAN, O.D., INC

Provider Business Mailing Address
First Line	:	5229 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5538
Country	:	US
Telephone Number	:	260-484-1453
Fax Number	:	260-483-8287

Provider Business Practice Location Address
First Line	:	5229 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5538
Country	:	US
Telephone Number	:	260-484-1453
Fax Number	:	260-483-8287

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN RAY RUTAN
Credential	:	O.D.
Telephone Number	:	260-484-1453

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/06/2010

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