Provider Demographics
NPI:1487611190
Name:UPTON, AYNN L (OD)
Entity type:Individual
Prefix:DR
First Name:AYNN
Middle Name:L
Last Name:UPTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3996T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760332622OtherTAX ID
TX00E15QOtherBCBS
TX019231201Medicaid
TX00E15QMedicare ID - Type UnspecifiedTX MEDICARE
TX019231201Medicaid