Provider Demographics
NPI:1194871210
Name:AYNN L UPTON
Entity type:Organization
Organization Name:AYNN L UPTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AYNN
Authorized Official - Middle Name:L
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-993-5882
Mailing Address - Street 1:5700 S STAPLES ST
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3784
Mailing Address - Country:US
Mailing Address - Phone:361-993-5882
Mailing Address - Fax:
Practice Address - Street 1:5700 S STAPLES ST
Practice Address - Street 2:SUITE C-4
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3784
Practice Address - Country:US
Practice Address - Phone:361-993-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3996T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E15QOtherBCBS
00E15QMedicare PIN