MEDICARE: DR. CLAYTON WILLIAM RUTKOWSKI OD

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	9376T	TX

General Provider Information

NPI Number	:	1093295305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON WILLIAM RUTKOWSKI OD

Provider Business Mailing Address
First Line	:	5401 E. PARMER LANE
Second Line	:	APT 5332
City	:	AUSTIN
State	:	TX
Zip	:	78754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 HWY 290 E
Second Line	:
City	:	ELGIN
State	:	TX
Zip	:	78621-2018
Country	:	US
Telephone Number	:	512-285-2015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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