MEDICARE: JOE B. RUPE O.D.

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	:	1700821006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE B. RUPE O.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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