Provider Demographics
NPI:1225115058
Name:EYE CARE OF MCCONNELSVILLE LLC
Entity Type:Organization
Organization Name:EYE CARE OF MCCONNELSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-962-4281
Mailing Address - Street 1:71 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCCONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-1180
Mailing Address - Country:US
Mailing Address - Phone:740-962-4281
Mailing Address - Fax:740-962-5741
Practice Address - Street 1:71 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-1180
Practice Address - Country:US
Practice Address - Phone:740-962-4281
Practice Address - Fax:740-962-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854295Medicaid
OH=========00OtherBUREAU OF WORKERS COMPENSATION
OH=========00OtherBUREAU OF WORKERS COMPENSATION
OH9321511Medicare PIN
OHV06057Medicare UPIN
OH4497820001Medicare NSC
OHU19160Medicare UPIN