=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609244649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUFARO MUDZINGANYAMA AND ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2015
-----------------------------------------------------
Last Update Date | 09/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8147 AUTUMN PL
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-8258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-446-1154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8147 AUTUMN PL
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-8258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | RUFARO MUDZINGANYAMA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 614-446-1154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5964
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------