Provider Demographics
NPI:1578640678
Name:RUGGIERO, THERESA J (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:J
Last Name:RUGGIERO
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 1:86 MASONIC STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1833
Mailing Address - Country:US
Mailing Address - Phone:413-586-5002
Mailing Address - Fax:413-586-4769
Practice Address - Street 1:86 MASONIC STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1833
Practice Address - Country:US
Practice Address - Phone:413-586-5002
Practice Address - Fax:413-586-4769
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA04-3192348152W00000X, 152WL0500X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15722OtherBLUE CROSS BLUE SHIELD
MAW15722OtherBLUE CROSS BLUE SHIELD