Healthcare Provider Details

I. General information

NPI: 1649229196
Provider Name (Legal Business Name): STEVEN E RUHENKAMP OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/10/2008
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
45380-9561
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-3206
  • Fax: 937-526-3203
Mailing address:
  • Phone: 937-526-3206
  • Fax: 937-526-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4676
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: