Provider Demographics
NPI:1447369798
Name:WEBER, RUTH ANN (OD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081B W FOND DU LAC ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-9260
Mailing Address - Country:US
Mailing Address - Phone:920-748-1497
Mailing Address - Fax:920-748-1492
Practice Address - Street 1:1081B W FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9260
Practice Address - Country:US
Practice Address - Phone:920-748-1497
Practice Address - Fax:920-748-1492
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WITPA2317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU45332Medicare UPIN
WI000671057Medicare PIN
WI38605600Medicaid
WI410039206OtherRAILRAOD MEDICARE PIN
WICI7005OtherRAILROAD MEDICARE GROUP #