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NPI Code Detail

MEDICARE: DR. DEEPAK GUPTA O.D.

MEDICARE: DR. DEEPAK GUPTA O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist002532CT

General Provider Information

NPI Number : 1194888743
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEEPAK GUPTA O.D.
Provider Business Mailing Address
First Line : 680 BOSTON POST RD # 5
Second Line : SUITE 5
City : MILFORD
State : CT
Zip : 06460-2684
Country : US
Telephone Number : 203-889-8578
Fax Number : 203-283-5226
Provider Business Practice Location Address
First Line : 680 BOSTON POST RD
Second Line : UNIT 5
City : MILFORD
State : CT
Zip : 06460-2684
Country : US
Telephone Number : 203-888-8578
Fax Number : 203-283-5226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 05/22/2014

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