MEDICARE: CASTLE VALLEY EYECARE PC

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
1	152W00000X	Optometrist	114028-9934	UT

General Provider Information

NPI Number	:	1174551246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE VALLEY EYECARE PC

Provider Business Mailing Address
First Line	:	PO BOX 785
Second Line	:
City	:	CASTLE DALE
State	:	UT
Zip	:	84513-0785
Country	:	US
Telephone Number	:	435-381-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 EAST MAIN
Second Line	:
City	:	CASTLE DALE
State	:	UT
Zip	:	84513-0785
Country	:	US
Telephone Number	:	435-381-2040
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	STEVEN ORLAND TUTTLE
Credential	:	O.D.
Telephone Number	:	435-381-2040

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	06/06/2013

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