Provider Demographics
NPI:1962718288
Name:GUPTA, DAMAN TOOR (OD)
Entity type:Individual
Prefix:DR
First Name:DAMAN
Middle Name:TOOR
Last Name:GUPTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25230 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1715
Mailing Address - Country:US
Mailing Address - Phone:313-441-2227
Mailing Address - Fax:313-441-2241
Practice Address - Street 1:25230 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1715
Practice Address - Country:US
Practice Address - Phone:313-441-2227
Practice Address - Fax:313-441-2241
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist