Provider Demographics
NPI:1336121086
Name:DUPUIS, ERIC PHILLIP (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PHILLIP
Last Name:DUPUIS
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 1:1836 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1016
Mailing Address - Country:US
Mailing Address - Phone:954-594-4483
Mailing Address - Fax:
Practice Address - Street 1:8165 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5711
Practice Address - Country:US
Practice Address - Phone:954-594-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT2556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty