Healthcare Provider Details

I. General information

NPI: 1861223091
Provider Name (Legal Business Name): RUDD VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 S MERIDIAN STE 300
PUYALLUP WA
98373-1283
US

IV. Provider business mailing address

2910 S MERIDIAN STE 300
PUYALLUP WA
98373-1283
US

V. Phone/Fax

Practice location:
  • Phone: 360-791-8404
  • Fax: 360-791-8404
Mailing address:
  • Phone: 360-791-8404
  • Fax: 360-791-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAY RUDD
Title or Position: OWNER/CEO
Credential:
Phone: 360-791-8404