MEDICARE: DR. STEVEN ORLAND TUTTLE 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	114028-9934	UT

General Provider Information

NPI Number	:	1912981036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ORLAND TUTTLE O.D.

Provider Business Mailing Address
First Line	:	190 EAST MAIN STREET
Second Line	:	P.O. BOX 785
City	:	CASTLE DALE
State	:	UT
Zip	:	84513
Country	:	US
Telephone Number	:	435-381-2040
Fax Number	:	435-381-2475

Provider Business Practice Location Address
First Line	:	190 EAST MAIN STREET
Second Line	:
City	:	CASTLE DALE
State	:	UT
Zip	:	84513
Country	:	US
Telephone Number	:	435-381-2040
Fax Number	:	435-381-2475

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	09/15/2011

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