Provider Demographics
NPI:1750392775
Name:RUTKOSKI, SCOTT P (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:RUTKOSKI
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 1:15 MEADE ST
Mailing Address - Street 2:SUITE U-1
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-724-2131
Mailing Address - Fax:570-724-5471
Practice Address - Street 1:15 MEADE ST
Practice Address - Street 2:SUITE U-1
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1813
Practice Address - Country:US
Practice Address - Phone:570-724-2131
Practice Address - Fax:570-724-5471
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015506950005Medicaid
PA791927Medicare PIN
PA0015506950005Medicaid