Individual
DR. MARTIN BRUCE RUDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
28923 CHRISTOPHER LN., SOUTHFIELD, MI 48034
(734) 358-3669
Mailing address
28923 CHRISTOPHER LN., SOUTHFIELD, MI 48034
(734) 358-3669
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003029
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831275759
—
MI
01
—
5330000967
BOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE
MI
01
—
MI6843015
PTAN
—
Enumeration date
10/31/2006
Last updated
05/01/2016
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