Provider Demographics
NPI:1053303339
Name:RUIZ, MARK AARON (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:AARON
Last Name:RUIZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 OLD MILL RUN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4214
Mailing Address - Country:US
Mailing Address - Phone:972-494-2020
Mailing Address - Fax:972-276-5664
Practice Address - Street 1:1821 OLD MILL RUN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4214
Practice Address - Country:US
Practice Address - Phone:972-494-2020
Practice Address - Fax:972-276-5664
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5317TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0192916 01Medicaid
TXU62255Medicare UPIN
TX00E28VMedicare ID - Type Unspecified