Provider Demographics
NPI:1861656589
Name:JEANNE I RUFF OD LLC
Entity Type:Organization
Organization Name:JEANNE I RUFF OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:IVY
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-229-4222
Mailing Address - Street 1:5223 MONTICELLO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8236
Mailing Address - Country:US
Mailing Address - Phone:757-229-4222
Mailing Address - Fax:855-646-7442
Practice Address - Street 1:5223 MONTICELLO AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8236
Practice Address - Country:US
Practice Address - Phone:757-229-4222
Practice Address - Fax:855-646-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV07672Medicare UPIN