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General NPI Number Information
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NPI Number | 1033349055
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Entity Type | Individual
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Provider Name | KATHLEEN SIMMS RUDOLF O. D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 2850 CENTRE DR STE 6A
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City | BEAVERCREEK
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State | OH
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Zip | 45324-8611
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Country | US
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Telephone | 937-294-4060
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Fax | 937-306-5245
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Provider Business Mailing Address
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Address Line | 2850 CENTRE DR STE 6A
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City | BEAVERCREEK
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State | OH
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Zip | 45324-8611
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Country | US
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Telephone | 937-294-4060
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Fax | 937-306-5245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5891/T2805
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License Number State | OH
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