Provider Demographics
NPI:1649229196
Name:RUHENKAMP, STEVEN E (OD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:E
Last Name:RUHENKAMP
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 1:10484 KLEY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9561
Mailing Address - Country:US
Mailing Address - Phone:937-526-3206
Mailing Address - Fax:937-526-3203
Practice Address - Street 1:10484 KLEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9561
Practice Address - Country:US
Practice Address - Phone:937-526-3206
Practice Address - Fax:937-526-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU58979Medicare UPIN
OHRU0791451Medicare Oscar/Certification
OH1071200001Medicare NSC
OHRUO791451Medicare ID - Type Unspecified