Provider Demographics
NPI:1518260892
Name:DAVID H. UPTON, INC
Entity Type:Organization
Organization Name:DAVID H. UPTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-646-5332
Mailing Address - Street 1:PO BOX 1553
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-1553
Mailing Address - Country:US
Mailing Address - Phone:207-646-5332
Mailing Address - Fax:207-646-9563
Practice Address - Street 1:1662 POST RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4638
Practice Address - Country:US
Practice Address - Phone:207-646-5332
Practice Address - Fax:207-646-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
704598Medicare PIN
T79567Medicare UPIN