Healthcare Provider Details

I. General information

NPI: 1265724884
Provider Name (Legal Business Name): RUCKMAN EYECARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W TENTH ST
CARSON CITY NV
89703-5201
US

IV. Provider business mailing address

111 W TENTH ST
CARSON CITY NV
89703-5201
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-4664
  • Fax:
Mailing address:
  • Phone: 775-883-4664
  • Fax: 775-883-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number638
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number638
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number638
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number638
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number638
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number638
License Number StateNV

VIII. Authorized Official

Name: RAYMOND J RUCKMAN
Title or Position: PRESIDENT/OPTOMETRIST
Credential: OD
Phone: 775-461-6179