Provider Demographics
NPI:1164468898
Name:RUSH, DONALD B (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:RUSH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:300 PLAZA CT
Mailing Address - Street 2:STE A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8260
Mailing Address - Country:US
Mailing Address - Phone:570-421-8842
Mailing Address - Fax:570-476-5842
Practice Address - Street 1:300 PLAZA CT
Practice Address - Street 2:STE A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8260
Practice Address - Country:US
Practice Address - Phone:570-421-8842
Practice Address - Fax:570-476-5842
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOE005042P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016250070004Medicaid
PA0016250070004Medicaid