Provider Demographics
NPI:1720543093
Name:RUPP, RAE ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:ELLEN
Last Name:RUPP
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 1:3649 CATCLAW DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8249
Mailing Address - Country:US
Mailing Address - Phone:325-371-6902
Mailing Address - Fax:
Practice Address - Street 1:3649 CATCLAW DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8249
Practice Address - Country:US
Practice Address - Phone:325-271-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist