Provider Demographics
NPI:1972754182
Name:RAUTIO, JEFFREY E (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
Last Name:RAUTIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40053 8 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1954
Mailing Address - Country:US
Mailing Address - Phone:248-348-1330
Mailing Address - Fax:
Practice Address - Street 1:40053 8 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1954
Practice Address - Country:US
Practice Address - Phone:248-348-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003087152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management