Individual provider Active NPI

Raelyn Ruiz

  • Optometrist
  • Sacramento, CA
National Provider Identifier
1790676708
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
36052 Issued in CA
Practice address
2409 15TH St
Sacramento, CA 95818-2238
Phone
(916) 443-8034
NPI assigned
Jul 9, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 36052 CA Primary

Addresses

Primary practice location

2409 15TH St
Sacramento, CA 95818-2238

Mailing address

8456 Bolcetto Cir
Elk Grove, CA 95757-0002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260429003684 CA Practitioner - Optometry 6002383726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

8456 Bolcetto Cir
Elk Grove, CA 95757-0002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jessica Huynh OD PC Optometrist CurrentSince Jul 13, 2025 Accepting new patients
Kubo & Kubo, O.D.S Optometrist PastSince Jul 13, 2025 Accepting new patients

Locations

2409 15th St
Sacramento, CA 95818
Phone (916) 335-9655

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1790676708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8456 BOLCETTO CIR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957570002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 15TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958182238",
            "telephone_number": "916-443-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "RAELYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "36052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.