Provider Demographics
NPI:1821119108
Name:RUDOLPH, DAVID HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOWARD
Last Name:RUDOLPH
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 1:206 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3121
Mailing Address - Country:US
Mailing Address - Phone:215-945-0558
Mailing Address - Fax:215-945-4162
Practice Address - Street 1:206 WILLOW DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-3121
Practice Address - Country:US
Practice Address - Phone:215-945-0558
Practice Address - Fax:215-945-4162
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE001136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist