Provider Demographics
NPI:1770896524
Name:MUDZINGANYAMA, RUFARO P (OD)
Entity type:Individual
Prefix:
First Name:RUFARO
Middle Name:P
Last Name:MUDZINGANYAMA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RUFARO
Other - Middle Name:P
Other - Last Name:MBOKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4274 PORTOBELLO DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5418
Mailing Address - Country:US
Mailing Address - Phone:614-446-1154
Mailing Address - Fax:
Practice Address - Street 1:4274 PORTOBELLO DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-5418
Practice Address - Country:US
Practice Address - Phone:614-446-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.5964-THER152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist