Provider Demographics
NPI:1093232456
Name:RUCK, CAILYN KATSEV (OD)
Entity Type:Individual
Prefix:DR
First Name:CAILYN
Middle Name:KATSEV
Last Name:RUCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAILYN
Other - Middle Name:CHRISTINE
Other - Last Name:KATSEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2946 DE LA VINA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3310
Mailing Address - Country:US
Mailing Address - Phone:805-967-9990
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:2946 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3310
Practice Address - Country:US
Practice Address - Phone:314-432-1134
Practice Address - Fax:314-432-1135
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017020394152W00000X
CAOPT33892TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33892TLGOtherLICENSE