Individual
MARIA GUADALUPE RUIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3109 E 1ST ST, VIDALIA, GA 30474-8830
(912) 537-2062
Mailing address
3109 E 1ST ST, VIDALIA, GA 30474-8830
(912) 537-2062
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO002791
GA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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