MEDICARE: DR. JEFFREY E RAUTIO 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	152WC0802X	Corneal and Contact Management Optometrist	4901003087	MI
2	152W00000X	Optometrist	4901003087	MI

General Provider Information

NPI Number	:	1972754182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY E RAUTIO O.D.

Provider Business Mailing Address
First Line	:	40053 8 MILE RD STE 100
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-1954
Country	:	US
Telephone Number	:	248-348-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	40053 8 MILE RD STE 100
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-1954
Country	:	US
Telephone Number	:	248-348-1330
Fax Number	:

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

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	07/25/2024

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