Provider Demographics
NPI:1720438195
Name:RUED, CORY THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:THOMAS
Last Name:RUED
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 1:1513 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4801
Mailing Address - Country:US
Mailing Address - Phone:920-725-1566
Mailing Address - Fax:920-725-8810
Practice Address - Street 1:1513 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4801
Practice Address - Country:US
Practice Address - Phone:920-725-1566
Practice Address - Fax:920-725-8810
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3419 - 35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist