Provider Demographics
NPI:1710307897
Name:PRUPES, DARY
Entity Type:Individual
Prefix:
First Name:DARY
Middle Name:
Last Name:PRUPES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 N TARRANT PKWY
Mailing Address - Street 2:STE. 108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7201
Mailing Address - Country:US
Mailing Address - Phone:817-656-0440
Mailing Address - Fax:817-428-4262
Practice Address - Street 1:5860 N TARRANT PKWY
Practice Address - Street 2:STE. 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7201
Practice Address - Country:US
Practice Address - Phone:817-656-0440
Practice Address - Fax:817-428-4262
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician