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General NPI Number Information
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NPI Number | 1639347743
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Entity Type | Organization
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Legal Business Name | CHARLES H. RUTAN, O.D.
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 224 ELM ST
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City | CLINTON
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State | IN
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Zip | 47842-2312
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Country | US
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Telephone | 765-832-3292
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Fax | 765-832-9730
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Provider Business Mailing Address
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Address Line | 224 ELM ST
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City | CLINTON
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State | IN
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Zip | 47842-2312
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Country | US
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Telephone | 765-832-3292
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Fax | 765-832-9730
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Authorized Official
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Title or Position | OWNER / OPTOMETRIST
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Name | CHARLES HUGH RUTAN
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Credential | O.D.
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Telephone | 765-832-3292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 18002266A
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License Number State | IN
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