Provider Demographics
NPI:1902377765
Name:BEYDOUN, RUDYNA (OD)
Entity Type:Individual
Prefix:DR
First Name:RUDYNA
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23728 CHERRY HILL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1418
Mailing Address - Country:US
Mailing Address - Phone:914-588-3196
Mailing Address - Fax:
Practice Address - Street 1:23000 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6039
Practice Address - Country:US
Practice Address - Phone:734-374-8500
Practice Address - Fax:734-374-0957
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist