MEDICARE: DR. RONALD C TUTT OD MS FAAO

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	4036	TX
2	152W00000X	Optometrist	973	NE

General Provider Information

NPI Number	:	1821076902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD C TUTT OD MS FAAO

Provider Business Mailing Address
First Line	:	18618 PALOMA PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-3587
Country	:	US
Telephone Number	:	210-497-6845
Fax Number	:	210-536-1359

Provider Business Practice Location Address
First Line	:	2507 KENNEDY CIRCLE BLDG 110
Second Line	:	USAFSAM/FECO
City	:	BROOKS CITY-BASE
State	:	TX
Zip	:	78235-5116
Country	:	US
Telephone Number	:	210-536-4534
Fax Number	:	210-536-1359

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	06/17/2008

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