Healthcare Provider Details

I. General information

NPI: 1790759090
Provider Name (Legal Business Name): DUANE P RUTZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S ATLANTIC
HALLOCK MN
56728
US

IV. Provider business mailing address

PO BOX 549
PARK RAPIDS MN
56470-0549
US

V. Phone/Fax

Practice location:
  • Phone: 218-843-2663
  • Fax: 218-843-2665
Mailing address:
  • Phone: 218-732-8535
  • Fax: 218-732-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1836
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: