MEDICARE: DR. ROBERT J. KUPSHO JR. 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	OEG000548	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780644872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J. KUPSHO JR. O.D.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 AIRPORT RD
Second Line	:
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-3361
Country	:	US
Telephone Number	:	570-459-9730
Fax Number	:	570-459-9736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/25/2020

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