Provider Demographics
NPI:1851640932
Name:RUPP, MELISSA A (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:RUPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SPITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1035 LAWRENCE DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601
Mailing Address - Country:US
Mailing Address - Phone:319-208-1843
Mailing Address - Fax:319-208-1846
Practice Address - Street 1:1035 LAWRENCE DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601
Practice Address - Country:US
Practice Address - Phone:319-208-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010618152W00000X
IA002561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist