Provider Demographics
NPI:1124997911
Name:RUIZ, JOSEPH (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16981 TORINO DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8546
Mailing Address - Country:US
Mailing Address - Phone:760-927-4389
Mailing Address - Fax:760-927-4389
Practice Address - Street 1:16981 TORINO DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8546
Practice Address - Country:US
Practice Address - Phone:760-927-4389
Practice Address - Fax:760-927-4389
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26897156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician