Healthcare Provider Details

I. General information

NPI: 1316992753
Provider Name (Legal Business Name): ROBERT F RUPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 S GLASSELL ST
ORANGE CA
92866-1906
US

IV. Provider business mailing address

436 S GLASSELL ST
ORANGE CA
92866-1906
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-6060
  • Fax: 714-633-7470
Mailing address:
  • Phone: 714-633-6060
  • Fax: 714-633-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC30076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: