MEDICARE: MR. DANIEL DAVID CERUTTI 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
1	152W00000X	Optometrist	TO2672	MO

General Provider Information

NPI Number	:	1649368713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL DAVID CERUTTI O.D.

Provider Business Mailing Address
First Line	:	10336 TOPAZ SPRING DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-6270
Country	:	US
Telephone Number	:	314-638-4123
Fax Number	:	314-961-1735

Provider Business Practice Location Address
First Line	:	9973 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1915
Country	:	US
Telephone Number	:	314-961-3151
Fax Number	:	314-961-1735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/09/2007

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