Provider Demographics
NPI:1215004247
Name:PULPAN, STEPHANIE DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DAWN
Last Name:PULPAN
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 1:805 S INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-3350
Mailing Address - Country:US
Mailing Address - Phone:806-435-5406
Mailing Address - Fax:806-435-5407
Practice Address - Street 1:2309 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5901
Practice Address - Country:US
Practice Address - Phone:806-435-5406
Practice Address - Fax:806-435-5407
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5924TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180403101Medicaid
0854440001OtherCIGNA GOVERNMENT SERVICES
TX81500QOtherBCBS
TXV07377Medicare UPIN
TX81500QOtherBCBS