Provider Demographics
NPI:1225062367
Name:RUAN, XIN (OD)
Entity Type:Individual
Prefix:DR
First Name:XIN
Middle Name:
Last Name:RUAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8925
Mailing Address - Country:US
Mailing Address - Phone:405-471-6220
Mailing Address - Fax:405-471-6220
Practice Address - Street 1:3101 NW 164TH TER
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9450
Practice Address - Country:US
Practice Address - Phone:405-471-6220
Practice Address - Fax:405-471-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200064570AMedicaid
OK200064570AMedicaid