=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942260914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID J DUPONT OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 05/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 LAC DE VILLE BLVD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-5646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-244-0332
-----------------------------------------------------
Fax | 585-473-8833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 LAC DE VILLE BLVD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-5646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-244-0332
-----------------------------------------------------
Fax | 585-473-8833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | T00499
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------