Healthcare Provider Details

I. General information

NPI: 1780724187
Provider Name (Legal Business Name): ROBERT PETER KUPSC O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TORREY ST STE 10
BROCKTON MA
02301-4849
US

IV. Provider business mailing address

119 PIERMONT ST
QUINCY MA
02170-2517
US

V. Phone/Fax

Practice location:
  • Phone: 508-587-0012
  • Fax: 508-587-0112
Mailing address:
  • Phone: 617-770-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3152
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: