Phillip K Ruprecht, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9697T Issued in CA

Practice address

1933 Central Ave Ste a
McKinleyville, CA 95519-3668

Phone

(707) 839-2828

Fax

(707) 839-3715

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851440713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 CENTRAL AVE STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193668",
            "telephone_number": "707-839-2828",
            "fax_number": "707-839-3715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 CENTRAL AVE STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193668",
            "telephone_number": "707-839-2828",
            "fax_number": "707-839-3715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUPRECHT",
        "first_name": "PHILLIP",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9697T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0096971",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marc Riggins Jr.
• Zachary Michael Roberts, LCSW
• Daniel Scott Robinson, RN
• Timothy Roettger
• Spencer Ian Ross
• S. Shaun Johanson DDS, Inc.
• Elwira Salata
• Melissa Salazar
• Laurie Goldberg Sanders, M.S., BCBA
• Karen Jean Santos, LCSW

• Optometrist in McKinleyville, CA
• Providers in McKinleyville, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.