Healthcare Provider Details

I. General information

NPI: 1912983107
Provider Name (Legal Business Name): MELANIE D RUOFF O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 WATSON RD
SAINT LOUIS MO
63119-4401
US

IV. Provider business mailing address

211 E BROADWAY
ALTON IL
62002-6220
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-5367
  • Fax: 314-352-0486
Mailing address:
  • Phone: 618-462-9818
  • Fax: 800-432-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2017001159
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: