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NPI Code Detail

MEDICARE: RONALD W DUTTON O.D.

MEDICARE: RONALD W DUTTON 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
1152W00000XOptometrist182NV

General Provider Information

NPI Number : 1033269485
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD W DUTTON O.D.
Provider Business Mailing Address
First Line : 1601 E BASIN AVE
Second Line : SUITE 101
City : PAHRUMP
State : NV
Zip : 89060-4611
Country : US
Telephone Number : 775-751-1791
Fax Number : 775-751-3991
Provider Business Practice Location Address
First Line : 1601 E BASIN AVE
Second Line : SUITE 101
City : PAHRUMP
State : NV
Zip : 89060-4611
Country : US
Telephone Number : 775-751-1791
Fax Number : 775-751-3991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 01/12/2016

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