Healthcare Provider Details

I. General information

NPI: 1104500933
Provider Name (Legal Business Name): CHRISTINE RUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 S LOUISE AVE
SIOUX FALLS SD
57106-0704
US

IV. Provider business mailing address

3209 S LOUISE AVE
SIOUX FALLS SD
57106-0704
US

V. Phone/Fax

Practice location:
  • Phone: 605-362-2620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: