Provider Demographics
NPI:1700870284
Name:HRUZA, CARRIE T (OD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:T
Last Name:HRUZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BOWLES AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2395
Mailing Address - Country:US
Mailing Address - Phone:636-717-1700
Mailing Address - Fax:636-203-4727
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:636-717-1700
Practice Address - Fax:636-203-4727
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000091424Medicare ID - Type Unspecified
MOU94122Medicare UPIN