Provider Demographics
NPI:1184696510
Name:RUSCETT, RONDA VICTORIA (OD)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:VICTORIA
Last Name:RUSCETT
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:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-846-4200
Mailing Address - Fax:616-846-4200
Practice Address - Street 1:17088 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-846-4200
Practice Address - Fax:616-846-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2919001Medicare PIN
MI4714150001Medicare NSC