Provider Demographics
NPI:1467450213
Name:DUPUIS, DENNIS PHILLIP (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
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:303-449-2401
Mailing Address - Fax:720-563-0157
Practice Address - Street 1:1836 30TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1016
Practice Address - Country:US
Practice Address - Phone:303-449-2401
Practice Address - Fax:720-563-0157
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT92222Medicare UPIN
CO40003Medicare ID - Type Unspecified