Provider Demographics
NPI:1316781800
Name:LUTTRELL, PAUL ISAAC (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ISAAC
Last Name:LUTTRELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:606 NC MUSIC FACTORY BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-6023
Mailing Address - Country:US
Mailing Address - Phone:937-728-7064
Mailing Address - Fax:
Practice Address - Street 1:606 NC MUSIC FACTORY BLVD APT 305
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-6023
Practice Address - Country:US
Practice Address - Phone:937-728-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT.2493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist