Healthcare Provider Details

I. General information

NPI: 1659358257
Provider Name (Legal Business Name): JOSEPH JEFFREY RUDINSKY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 LINCOLN AVENUE EXT
CHARLEROI PA
15022-3080
US

IV. Provider business mailing address

5913 KINGS SCHOOL RD 5913 KINGS SCHOOL ROAD
BETHEL PARK PA
15102-3367
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-2777
  • Fax:
Mailing address:
  • Phone: 724-483-2777
  • Fax: 412-831-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001415
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: