MEDICARE: DR. BRYANT PAUL CARRUTH MD

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	207W00000X	Ophthalmology Physician	260147	NY
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	260147	NY

General Provider Information

NPI Number	:	1760645790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYANT PAUL CARRUTH MD

Provider Business Mailing Address
First Line	:	3400 VICKERY RD
Second Line	:	SUITE A
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4540
Country	:	US
Telephone Number	:	315-422-3937
Fax Number	:	315-422-4432

Provider Business Practice Location Address
First Line	:	3400 VICKERY RD
Second Line	:	SUITE A
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4540
Country	:	US
Telephone Number	:	315-422-3937
Fax Number	:	315-422-4432

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	03/19/2025

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