MEDICARE: CHRISTOPHER ROBERT RUGABER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000475	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00227450	OTHER		MEDICARE PIN (RR)

General Provider Information

NPI Number	:	1548260532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ROBERT RUGABER OD

Provider Business Mailing Address
First Line	:	104 W SLIPPERY ROCK ST
Second Line	:	PO BOX 550
City	:	CHICORA
State	:	PA
Zip	:	16025-3212
Country	:	US
Telephone Number	:	724-445-3901
Fax Number	:	724-445-0031

Provider Business Practice Location Address
First Line	:	104 W SLIPPERY ROCK ST
Second Line	:	BOX 550
City	:	CHICORA
State	:	PA
Zip	:	16025-3212
Country	:	US
Telephone Number	:	724-445-3901
Fax Number	:	724-445-0031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2005
Last Update Date	:	01/18/2011

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