Provider Demographics
NPI:1891075578
Name:RUCKMAN, CARLI (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLI
Middle Name:
Last Name:RUCKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CARLI
Other - Middle Name:
Other - Last Name:BORCHERDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8701 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-4183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4537
Practice Address - Country:US
Practice Address - Phone:863-299-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist