Healthcare Provider Details

I. General information

NPI: 1942260914
Provider Name (Legal Business Name): DAVID J DUPONT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LAC DE VILLE BLVD
ROCHESTER NY
14618-5646
US

IV. Provider business mailing address

2301 LAC DE VILLE BLVD
ROCHESTER NY
14618-5646
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-0332
  • Fax: 585-473-8833
Mailing address:
  • Phone: 585-244-0332
  • Fax: 585-473-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT00499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: