Provider Demographics
NPI:1790915874
Name:RUPP, CHRISTOPHER DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DEAN
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 1:3559 LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-6522
Mailing Address - Country:US
Mailing Address - Phone:812-320-5152
Mailing Address - Fax:
Practice Address - Street 1:6404 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2351
Practice Address - Country:US
Practice Address - Phone:402-466-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist