Healthcare Provider Details

I. General information

NPI: 1811966674
Provider Name (Legal Business Name): MICHAEL JAMES HUTTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 3RD ST
LEWISTOWN PA
17044-1716
US

IV. Provider business mailing address

19 W 3RD ST
LEWISTOWN PA
17044-1716
US

V. Phone/Fax

Practice location:
  • Phone: 717-248-5678
  • Fax: 717-242-2716
Mailing address:
  • Phone: 717-248-5678
  • Fax: 717-242-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000613
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: