Healthcare Provider Details

I. General information

NPI: 1528247285
Provider Name (Legal Business Name): STEVEN E RUHENKAMP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10484 KLEY RD SUITE D
VERSAILLES OH
45380-9561
US

IV. Provider business mailing address

10484 KLEY RD SUITE D
VERSAILLES OH
45380-9611
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-3206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN E RUHENKAMP
Title or Position: OWNER DOCTOR
Credential: OD
Phone: 937-526-3206