Provider Demographics
NPI:1013192814
Name:JOSEPH L TRUPO
Entity Type:Organization
Organization Name:JOSEPH L TRUPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRUPO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-636-2020
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV601-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0485700001Medicare NSC