Provider Demographics
NPI:1578515920
Name:RUDGE, ROBERT STANLEY (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STANLEY
Last Name:RUDGE
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 1:602 WEST ST
Mailing Address - Street 2:P.O.BOX 280
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-0280
Mailing Address - Country:US
Mailing Address - Phone:740-732-2304
Mailing Address - Fax:
Practice Address - Street 1:602 WEST ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-0280
Practice Address - Country:US
Practice Address - Phone:740-732-2304
Practice Address - Fax:740-732-2305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist