Provider Demographics
NPI:1174666101
Name:RUGGLES, PATRICK PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PAUL
Last Name:RUGGLES
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 1:2140 ETHEL ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-4013
Mailing Address - Country:US
Mailing Address - Phone:989-878-0389
Mailing Address - Fax:
Practice Address - Street 1:3801 WILDER RD
Practice Address - Street 2:STE 4
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2301
Practice Address - Country:US
Practice Address - Phone:989-778-1414
Practice Address - Fax:989-402-1467
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist