MEDICARE: RUBY VO 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	36092	CA

General Provider Information

NPI Number	:	1225911795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY VO OD

Provider Business Mailing Address
First Line	:	11733 FAIR OAKS BLVD
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11733 FAIR OAKS BLVD
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2816
Country	:	US
Telephone Number	:	916-966-6080
Fax Number	:

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

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	08/13/2025

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Directions to “ RUBY VO OD” Practice Location

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