Provider Demographics
NPI:1992085179
Name:RAPP, JUSTIN (OD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:RAPP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 W MAIN ST # 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4523
Mailing Address - Country:US
Mailing Address - Phone:203-861-9200
Mailing Address - Fax:
Practice Address - Street 1:2046 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4523
Practice Address - Country:US
Practice Address - Phone:203-869-3082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0280291Medicaid
NYA400069923Medicare PIN
NJ230703Medicare UPIN