MEDICARE: JOE B RUPE OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1889T	TX

General Provider Information

NPI Number	:	1316185853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOE B RUPE OD INC

Provider Business Mailing Address
First Line	:	1708 KELL BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5627
Country	:	US
Telephone Number	:	940-766-0012
Fax Number	:	940-766-5300

Provider Business Practice Location Address
First Line	:	1708 KELL BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5627
Country	:	US
Telephone Number	:	940-766-0012
Fax Number	:	940-766-5300

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOE B RUPE
Credential	:	O.D
Telephone Number	:	940-766-0012

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/07/2011

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