MEDICARE: DARY PRUPES

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
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1710307897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARY PRUPES

Provider Business Mailing Address
First Line	:	5860 N TARRANT PKWY
Second Line	:	STE. 108
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7201
Country	:	US
Telephone Number	:	817-656-0440
Fax Number	:	817-428-4262

Provider Business Practice Location Address
First Line	:	5860 N TARRANT PKWY
Second Line	:	STE. 108
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7201
Country	:	US
Telephone Number	:	817-656-0440
Fax Number	:	817-428-4262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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Directions to “ DARY PRUPES ” Practice Location

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