MEDICARE: DR. CAILYN KATSEV RUCK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2017020394	MO
2	152W00000X	Optometrist	OPT33892TLG	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33892TLG	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1093232456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAILYN KATSEV RUCK OD

Provider Business Mailing Address
First Line	:	2946 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3310
Country	:	US
Telephone Number	:	805-967-9990
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	2946 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3310
Country	:	US
Telephone Number	:	314-432-1134
Fax Number	:	314-432-1135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	10/18/2022

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