Provider Demographics
NPI:1316992753
Name:RUPER, ROBERT F (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:RUPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 S GLASSELL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1906
Mailing Address - Country:US
Mailing Address - Phone:714-633-6060
Mailing Address - Fax:714-633-7470
Practice Address - Street 1:436 S GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1906
Practice Address - Country:US
Practice Address - Phone:714-633-6060
Practice Address - Fax:714-633-7470
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30076207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75971ZOtherBLUE SHIELD
CA00C300760Medicaid
CA5710517Medicaid
CA180024089Medicare PIN
CAZZZ75971ZOtherBLUE SHIELD
CAA34116Medicare UPIN