Healthcare Provider Details

I. General information

NPI: 1699726687
Provider Name (Legal Business Name): JAY CHARLES RUDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
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: 253-650-0908
  • Fax: 253-319-4089
Mailing address:
  • Phone: 360-791-8404
  • Fax: 360-791-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberMD00038444
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00038444
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: