Provider Demographics
NPI:1285707265
Name:RUTLEDGE, LARRY G (OD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 ALLEN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-8763
Mailing Address - Country:US
Mailing Address - Phone:513-965-2020
Mailing Address - Fax:513-965-2025
Practice Address - Street 1:1107 ALLEN DR
Practice Address - Street 2:SUITE C
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8763
Practice Address - Country:US
Practice Address - Phone:513-965-2020
Practice Address - Fax:513-965-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3266152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000011879OtherBLUE CROSS & BLUE
22-00925OtherUNITED HEALTHCARE
311157870004OtherMEDICAL MUTUAL
311157870OtherVSP
3266OtherHUMANA
32843OtherCOORDINATED VISION CARE
OH3266OtherEYEMED
311157870OtherCIGNA
OH000000011879OtherBLUE CROSS & BLUE
311157870OtherCIGNA