Provider Demographics
NPI:1649378142
Name:RUCK, DONALD P (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:RUCK
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 1:511 W MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2213
Mailing Address - Country:US
Mailing Address - Phone:920-233-7825
Mailing Address - Fax:920-233-7825
Practice Address - Street 1:511 W MURDOCK AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2213
Practice Address - Country:US
Practice Address - Phone:920-233-7825
Practice Address - Fax:920-233-7825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1710-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38510300Medicaid
WIT63159Medicare UPIN
WI0000087314Medicare NSC
WI0802760001Medicare NSC