| Doctor Name: | TERESA RUCH |
| NPI Number: | 1578809364 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OPTICIAN |
| License Number: | 157064 |
| Business Practice Address: | 223 E Main St Waupun, WI - 539632019 |
| Business Phone Number: | 9203248608 |
| Business Fax Number: | 9203248699 |
| Mailing Address: | 223 E Main St, P.o. Box 163 WAUPUN |
| State: | WI |
| Postal Code: | 539632019 |
| Phone Number: | 9203248608 |
| Fax Number: | 9203248699 |
| NPI Enumeration Date: | 12/24/2012 |
| NPI Last Update Date: | 12/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 157064 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |