MEDICARE: RUTH J CHEN OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1023777422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTH J CHEN OD INC

Provider Business Mailing Address
First Line	:	1051 SOLANO AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1650
Country	:	US
Telephone Number	:	510-526-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 SOLANO AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1650
Country	:	US
Telephone Number	:	510-526-3937
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RUTH CHEN FRUIN
Credential	:	OD
Telephone Number	:	650-520-3888

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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