Provider Demographics
NPI:1811967946
Name:RUEDI, ALAN FREDERICK (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:FREDERICK
Last Name:RUEDI
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 1:92 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3204
Mailing Address - Country:US
Mailing Address - Phone:847-438-6966
Mailing Address - Fax:847-438-7977
Practice Address - Street 1:92 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3204
Practice Address - Country:US
Practice Address - Phone:847-438-6966
Practice Address - Fax:847-438-7977
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36201Medicare UPIN
IL0495990001Medicare ID - Type Unspecified
IL307870Medicare ID - Type Unspecified