Healthcare Provider Details

I. General information

NPI: 1821527276
Provider Name (Legal Business Name): DANE ANDREW KUPLICKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 10TH ST N STE 2C
ST PETERSBURG FL
33705-1407
US

IV. Provider business mailing address

14194 84TH TER
SEMINOLE FL
33776-2823
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-7134
  • Fax: 727-824-8329
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5442
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: