Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OP2720 | FL |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OP2720 | FL |
NPI | 1124062989 |
---|---|
Provider Name | Dr. Douglas Ronald Tupps |
First Address | Dunedin, FL 34698-5606 |
Second Address | Dunedin, FL 34698-5606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 25/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115712 | EYEMED (01) | FL |
20464 | BCBS (01) | FL |
U46999 | (02) | FL |