Provider Demographics
NPI:1760456479
Name:RUPNOW, PAMELA JO (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JO
Last Name:RUPNOW
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 1:19645 PILOT KNOB RD
Mailing Address - Street 2:STE 106
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7240
Mailing Address - Country:US
Mailing Address - Phone:952-948-1357
Mailing Address - Fax:
Practice Address - Street 1:19645 PILOT KNOB RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7239
Practice Address - Country:US
Practice Address - Phone:651-463-2020
Practice Address - Fax:651-463-2066
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1016339OtherPREFERRED ONE HEALTH PLAN
MN2201169OtherMEDICA HEALTH PLAN
MN084015400Medicaid
MN113289OtherPATIENT'S CHOICE
MN114544OtherUCARE
MN26019OtherAMERICA'S PPO
MN30041RUOtherBLUE CROSS/BLUE SHIELD
MN1016339OtherPREFERRED ONE HEALTH PLAN
MN114544OtherUCARE