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General NPI Number Information
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NPI Number | 1437486644
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Entity Type | Organization
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Legal Business Name | HEATHER A TUTTLE
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 810 COUNTY ROAD 42 W
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City | BURNSVILLE
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State | MN
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Zip | 55337-4426
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Country | US
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Telephone | 952-435-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 8360 KIMBALL DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-2129
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Country | US
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Telephone | 952-405-9850
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | HEATHER A TUTTLE
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Credential | O.D.
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Telephone | 952-405-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3092
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License Number State | MN
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