Provider Demographics
NPI:1548260532
Name:RUGABER, CHRISTOPHER ROBERT (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:RUGABER
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 1:104 W SLIPPERY ROCK ST
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-3212
Mailing Address - Country:US
Mailing Address - Phone:724-445-3901
Mailing Address - Fax:724-445-0031
Practice Address - Street 1:104 W SLIPPERY ROCK ST
Practice Address - Street 2:BOX 550
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-3212
Practice Address - Country:US
Practice Address - Phone:724-445-3901
Practice Address - Fax:724-445-0031
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00227450OtherMEDICARE PIN (RR)
P00227450OtherMEDICARE PIN (RR)
U24429Medicare UPIN