Provider Demographics
NPI:1386621985
Name:RUHL, MATTHEW W
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:RUHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 MT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2137
Mailing Address - Country:US
Mailing Address - Phone:319-754-2020
Mailing Address - Fax:319-754-2299
Practice Address - Street 1:2743 MT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2137
Practice Address - Country:US
Practice Address - Phone:319-754-2020
Practice Address - Fax:319-754-2299
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0467845Medicaid
IAP00291880OtherRAILROAD MEDICARE
V06316Medicare UPIN
IAP00291880OtherRAILROAD MEDICARE