Provider Demographics
NPI:1780724187
Name:KUPSC, ROBERT PETER (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PETER
Last Name:KUPSC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:119 PIERMONT ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2517
Mailing Address - Country:US
Mailing Address - Phone:617-770-2832
Mailing Address - Fax:
Practice Address - Street 1:21 TORREY ST STE 10
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4849
Practice Address - Country:US
Practice Address - Phone:508-587-0012
Practice Address - Fax:508-587-0112
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0717959Medicaid