=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619160389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUDEY OPTICIANS, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2007
-----------------------------------------------------
Last Update Date | 08/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 152 WEST SOUTH BOUNDARY
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-3661
-----------------------------------------------------
Fax | 419-872-5195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152 WEST SOUTH BOUNDARY
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-3661
-----------------------------------------------------
Fax | 419-872-5195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. RICKEY L RUDEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-874-3661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------