Physician Compare National (NPI:1821119108)

HEALTHCARE PROVIDER: DAVID HOWARD RUDOLPH O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1821119108
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173781564
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120319000300
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUDOLPH
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PENNSYLVANIA COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	206 WILLOW DR
	Group Practice or individual's line 1 address
City	LEVITTOWN
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	190543121
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2159450558
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y