Basic Information
| Provider Information | |||||||||
| NPI: | 1194058677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUDOWSKI EYECARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1618 LEE VICTORY PKWY | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154626835 | ||||||||
| FaxNumber: | 6154626836 | ||||||||
| Practice Location | |||||||||
| Address1: | 1618 LEE VICTORY PKWY | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154626835 | ||||||||
| FaxNumber: | 6154626836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2009 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | RUDOWSKI | ||||||||
| AuthorizedOfficialFirstName: | NICHOLE | ||||||||
| AuthorizedOfficialMiddleName: | TRANAS | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 6154626835 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2597 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.