Provider Demographics
NPI:1265502967
Name:RUPP, DANNY L (OD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:L
Last Name:RUPP
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 1:501 S WHITE ST STE 21
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2600
Mailing Address - Country:US
Mailing Address - Phone:319-385-2020
Mailing Address - Fax:319-385-6784
Practice Address - Street 1:501 S WHITE ST STE 21
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2600
Practice Address - Country:US
Practice Address - Phone:319-385-2020
Practice Address - Fax:319-385-6784
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0099259Medicaid
IA0206940001OtherDMERC
IA09925Medicare ID - Type Unspecified
IA0206940001OtherDMERC