Active NPI
Donald P Ruck, O.D.
- Optometrist
- Oshkosh, WI
National Provider Identifier
1649378142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1710-035
- Practice address
- 511 W Murdock Ave
Oshkosh, WI 54901-2213 - Phone
- (920) 233-7825
- Fax
- (920) 233-7825
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1710-035 | WI | Primary |
Addresses
Primary practice location
511 W Murdock Ave
Oshkosh, WI 54901-2213
Mailing address
511 W Murdock Ave
Oshkosh, WI 54901-2213
Phone (920) 233-7825
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38510300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1710-035 | WI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427241600000",
"number": "1649378142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 W MURDOCK AVE",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549012213",
"telephone_number": "920-233-7825",
"fax_number": "920-233-7825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 W MURDOCK AVE",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549012213",
"telephone_number": "920-233-7825",
"fax_number": "920-233-7825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUCK",
"first_name": "DONALD",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2015-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1710-035",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38510300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.