Provider Demographics
NPI:1477725554
Name:RUSOFF, HEMMA (VT)
Entity Type:Individual
Prefix:MS
First Name:HEMMA
Middle Name:
Last Name:RUSOFF
Suffix:
Gender:F
Credentials:VT
Other - Prefix:MS
Other - First Name:KARRIE
Other - Middle Name:
Other - Last Name:RUEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:VT
Mailing Address - Street 1:7373 147TH ST W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7690
Mailing Address - Country:US
Mailing Address - Phone:952-270-8032
Mailing Address - Fax:952-431-3909
Practice Address - Street 1:2705 BUNKER LAKE BLVD.
Practice Address - Street 2:SUITE B102
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304
Practice Address - Country:US
Practice Address - Phone:651-492-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3059152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy