Provider Demographics
NPI:1033349055
Name:RUDOLF, KATHLEEN SIMMS (O D)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SIMMS
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 CENTRE DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45324-8611
Mailing Address - Country:US
Mailing Address - Phone:937-294-4060
Mailing Address - Fax:937-306-5245
Practice Address - Street 1:2850 CENTRE DR STE 6A
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45324-8611
Practice Address - Country:US
Practice Address - Phone:937-294-4060
Practice Address - Fax:937-306-5245
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5891/T2805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist