Individual
CHARLES HUGH RUTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
224 ELM ST, CLINTON, IN 47842-2312
(765) 832-3292
(765) 832-9730
Mailing address
224 ELM ST, CLINTON, IN 47842-2312
(765) 832-3292
(765) 832-9730
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002266A
IN
152WC0802X
Corneal and Contact Management Optometrist
18002266A
IN
152WL0500X
Low Vision Rehabilitation Optometrist
1800226A
IN
152WP0200X
Pediatric Optometrist
18002266A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087765
BLUE CROSS BLUE SHIELD
IN
05
—
100243930
—
IN
01
—
100243930C
MEDICAID LOCATION C
IN
01
—
351776119
TRICARE
IN
Enumeration date
10/14/2005
Last updated
08/02/2012
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