Provider Demographics
NPI:1780638320
Name:CHRISTOPHER R RUGABER OD LLC
Entity type:Organization
Organization Name:CHRISTOPHER R RUGABER OD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RUGABER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-445-3901
Mailing Address - Street 1:104 W SLIPPERY ROCK ST
Mailing Address - Street 2:BOX 550
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-3212
Mailing Address - Country:US
Mailing Address - Phone:724-445-3901
Mailing Address - Fax:724-445-0031
Practice Address - Street 1:104 W SLIPPERY ROCK ST
Practice Address - Street 2:BOX 550
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-3212
Practice Address - Country:US
Practice Address - Phone:724-445-3901
Practice Address - Fax:724-445-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD 4305OtherMEDICAREPIN (RR)
091702Medicare PIN