Healthcare Provider Details

I. General information

NPI: 1124062989
Provider Name (Legal Business Name): DOUGLAS RONALD TUPPS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 MAIN ST
DUNEDIN FL
34698-5606
US

IV. Provider business mailing address

2161 MAIN ST
DUNEDIN FL
34698-5606
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-8843
  • Fax: 727-733-4313
Mailing address:
  • Phone: 727-734-8843
  • Fax: 727-733-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP2720
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOP2720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: