Provider Demographics
NPI:1629155106
Name:UPTON, DAVID HERBERT (OD OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HERBERT
Last Name:UPTON
Suffix:
Gender:M
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 ROAD
Practice Address - Street 2:ABENAKI PROFESSIONAL PARK
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-1553
Practice Address - Country:US
Practice Address - Phone:207-646-5332
Practice Address - Fax:207-646-9563
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME499T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0691700001Medicare NSC
T79567Medicare UPIN
ME704598Medicare ID - Type Unspecified