Healthcare Provider Details

I. General information

NPI: 1386621985
Provider Name (Legal Business Name): MATTHEW W RUHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 MT PLEASANT ST
BURLINGTON IA
52601-2137
US

IV. Provider business mailing address

2743 MT PLEASANT ST
BURLINGTON IA
52601-2137
US

V. Phone/Fax

Practice location:
  • Phone: 319-754-2020
  • Fax: 319-754-2299
Mailing address:
  • Phone: 319-754-2020
  • Fax: 319-754-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02328
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: