Provider Demographics
NPI:1942376058
Name:RUPRECHT, JENNIFER KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KAY
Last Name:RUPRECHT
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 1:1952 ADDISON AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5304
Mailing Address - Country:US
Mailing Address - Phone:208-735-4080
Mailing Address - Fax:
Practice Address - Street 1:1952 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5304
Practice Address - Country:US
Practice Address - Phone:208-735-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010139897OtherBLUE SHIELD - OPTOMETRIST