MEDICARE: DR. JAMES JOSEPH CUTLER O.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	152W00000X	Optometrist	CA9229T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93-1118263	OTHER		FEDERAL TAX ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	399-5653-7	OTHER	CA	STATE ID #

General Provider Information

NPI Number	:	1982702023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES JOSEPH CUTLER O.D.

Provider Business Mailing Address
First Line	:	1637 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-982-0100
Fax Number	:	909-985-1552

Provider Business Practice Location Address
First Line	:	1637 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-982-0100
Fax Number	:	909-985-1552

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/07/2014

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