Provider Demographics
NPI:1013989219
Name:RUIZ, DAVID AUSTIN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:AUSTIN
Last Name:RUIZ
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 1:416 N GRAY ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-5247
Mailing Address - Country:US
Mailing Address - Phone:254-634-7805
Mailing Address - Fax:254-634-1034
Practice Address - Street 1:416 N GRAY ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5247
Practice Address - Country:US
Practice Address - Phone:254-634-7805
Practice Address - Fax:254-634-1034
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2936TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0995120001OtherCIGNA GOVERMENT SERVICES
TX112302801Medicaid
TX00E05DMedicare PIN
TX112302801Medicaid
TX0995120001Medicare PIN