Provider Demographics
NPI:1306804596
Name:TRUPO, JOSEPH L (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:TRUPO
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 1:1506 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3355
Mailing Address - Country:US
Mailing Address - Phone:304-636-2020
Mailing Address - Fax:304-636-5911
Practice Address - Street 1:1506 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3355
Practice Address - Country:US
Practice Address - Phone:304-636-2020
Practice Address - Fax:304-636-5911
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV601-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550571839OtherWV CHIPS ID #
WV001719616OtherBC&BS PROVIDER #
WV0150524000Medicaid
WV0485700001OtherDMERC PRODIVER #
WV550571839OtherPEIA ID#
WV0646156OtherUMW PROVIDER #
WV406580461OtherRAILROAD PROVIDER #
WVT32507Medicare UPIN
WV9123842Medicare PIN