Provider Demographics
NPI:1750633913
Name:RUDEY OPTICIANS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RUDEY OPTICIANS & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-874-3661
Mailing Address - Street 1:152 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1754
Practice Address - Country:US
Practice Address - Phone:419-874-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5962 T2877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty