Provider Demographics
NPI:1811044688
Name:RUA, THERESA MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIA
Last Name:RUA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-957-3355
Mailing Address - Fax:631-991-6703
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE210
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3027
Practice Address - Country:US
Practice Address - Phone:631-957-3355
Practice Address - Fax:631-991-6703
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU84137Medicare UPIN
NYC113I1Medicare ID - Type Unspecified