MEDICARE: EYE CARE OF MCCONNELSVILLE LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225115058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE OF MCCONNELSVILLE LLC

Provider Business Mailing Address
First Line	:	71 E MAIN ST
Second Line	:
City	:	MCCONNELSVILLE
State	:	OH
Zip	:	43756-1180
Country	:	US
Telephone Number	:	740-962-4281
Fax Number	:	740-962-5741

Provider Business Practice Location Address
First Line	:	71 E MAIN ST
Second Line	:
City	:	MCCONNELSVILLE
State	:	OH
Zip	:	43756-1180
Country	:	US
Telephone Number	:	740-962-4281
Fax Number	:	740-962-5741

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK M RUFF
Credential	:	O.D.
Telephone Number	:	740-962-4281

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2021

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