=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912983107
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE D RUOFF O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 10/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7235 WATSON RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63119-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-352-5367
-----------------------------------------------------
Fax | 314-352-0486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E BROADWAY
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62002-6220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-462-9818
-----------------------------------------------------
Fax | 800-432-6004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2017001159
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------