Healthcare Provider Details

I. General information

NPI: 1518340181
Provider Name (Legal Business Name): JUSTIN KUIPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HALTON RD
GREENVILLE SC
29607-3403
US

IV. Provider business mailing address

1630 ADAMS ST
MANKATO MN
56001-6795
US

V. Phone/Fax

Practice location:
  • Phone: 864-458-7956
  • Fax: 864-458-8390
Mailing address:
  • Phone: 507-345-6151
  • Fax: 507-625-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number65213
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57.027461
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number86195
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: