Provider Demographics
NPI:1053093740
Name:MATHEW, RUHI (OD)
Entity type:Individual
Prefix:DR
First Name:RUHI
Middle Name:
Last Name:MATHEW
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 1:130 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1405
Mailing Address - Country:US
Mailing Address - Phone:203-397-3878
Mailing Address - Fax:203-397-9110
Practice Address - Street 1:130 AMITY RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1405
Practice Address - Country:US
Practice Address - Phone:203-397-3878
Practice Address - Fax:203-397-9110
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3313390200000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program