MEDICARE: DR. STEPHEN JOSEPH RUTH OD

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	3509	OH

General Provider Information

NPI Number	:	1144335779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JOSEPH RUTH OD

Provider Business Mailing Address
First Line	:	771 S 30TH ST
Second Line	:	SEARS OPTICAL
City	:	HEATH
State	:	OH
Zip	:	43056-4200
Country	:	US
Telephone Number	:	740-522-8846
Fax Number	:	740-522-8846

Provider Business Practice Location Address
First Line	:	771 S 30TH ST
Second Line	:	SEARS OPTICAL
City	:	HEATH
State	:	OH
Zip	:	43056-4200
Country	:	US
Telephone Number	:	740-522-8846
Fax Number	:	740-522-8846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/13/2007

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