Provider Demographics
NPI:1639358229
Name:TUPA, FAYE NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:NICOLE
Last Name:TUPA
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 1:1308 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5911
Mailing Address - Country:US
Mailing Address - Phone:361-573-2021
Mailing Address - Fax:361-573-4047
Practice Address - Street 1:1308 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5911
Practice Address - Country:US
Practice Address - Phone:361-573-2021
Practice Address - Fax:361-573-4047
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6286TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU93454Medicare UPIN