Provider Demographics
NPI:1831120096
Name:RUFF, MARK M (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:RUFF
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 1:111 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3107
Mailing Address - Country:US
Mailing Address - Phone:740-373-2069
Mailing Address - Fax:740-373-2069
Practice Address - Street 1:111 3RD ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3107
Practice Address - Country:US
Practice Address - Phone:740-373-2069
Practice Address - Fax:740-373-2069
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0682935Medicaid
OH0620905Medicare PIN
OH0620902Medicare PIN
OHU00283Medicare UPIN
OH0620903Medicare PIN
OH0682935Medicaid