Provider Demographics
NPI:1013017888
Name:RAPOPORT, STEVEN M (OD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:RAPOPORT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROPE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2806
Mailing Address - Country:US
Mailing Address - Phone:860-442-5012
Mailing Address - Fax:860-442-2908
Practice Address - Street 1:25 ROPE FERRY RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2806
Practice Address - Country:US
Practice Address - Phone:860-442-5012
Practice Address - Fax:860-442-2908
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4024683Medicaid
CT410000292Medicare ID - Type Unspecified
CTT22959Medicare UPIN