MEDICARE: RUTVI NORD M.D.

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	207W00000X	Ophthalmology Physician	E-12822	AR
2	207W00000X	Ophthalmology Physician	64611	TN

General Provider Information

NPI Number	:	1699120162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTVI NORD M.D.

Provider Business Mailing Address
First Line	:	668 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3951
Country	:	US
Telephone Number	:	731-424-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	668 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3951
Country	:	US
Telephone Number	:	731-426-8434
Fax Number	:

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	10/21/2022

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