Provider Demographics
NPI:1255118451
Name:RUIZ, LUIS RODRIGO (LDO)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RODRIGO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20307 MOUNTAIN HWY E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8101
Mailing Address - Country:US
Mailing Address - Phone:253-846-6503
Mailing Address - Fax:253-846-7986
Practice Address - Street 1:20307 MOUNTAIN HWY E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8101
Practice Address - Country:US
Practice Address - Phone:253-846-6503
Practice Address - Fax:253-846-7986
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60921006156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician