Basic Information
| Provider Information | |||||||||
| NPI: | 1790915874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUPP | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3559 LAURA AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688036522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123205152 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6404 O ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685102351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024663700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2009 | ||||||||
| LastUpdateDate: | 07/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1328 | NE | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.