Provider Demographics
NPI:1124062989
Name:TUPPS, DOUGLAS RONALD (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RONALD
Last Name:TUPPS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5606
Mailing Address - Country:US
Mailing Address - Phone:727-734-8843
Mailing Address - Fax:727-733-4313
Practice Address - Street 1:2161 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5606
Practice Address - Country:US
Practice Address - Phone:727-734-8843
Practice Address - Fax:727-733-4313
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2720152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115712OtherEYEMED
FL20464OtherBCBS
FLU46999Medicare UPIN
FL20464OtherBCBS