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General NPI Number Information
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NPI Number | 1972650943
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Entity Type | Individual
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Provider Name | ROSEANN MARIE RUPP-MAIOLATESI O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 117 LACKAWANNA AVE
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City | OLYPHANT
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State | PA
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Zip | 18447-1449
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Country | US
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Telephone | 570-383-9601
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Fax | 570-383-9613
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Provider Business Mailing Address
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Address Line | 42 SPRING ST
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City | CARBONDALE
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State | PA
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Zip | 18407-2027
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Country | US
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Telephone | 570-281-3332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE-007219-T
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License Number State | PA
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