Provider Demographics
NPI:1952458911
Name:CULPEPPER, PAUL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:CULPEPPER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 NORTHPARK DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3100
Mailing Address - Country:US
Mailing Address - Phone:423-283-4499
Mailing Address - Fax:423-283-0336
Practice Address - Street 1:2020 NORTHPARK DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3100
Practice Address - Country:US
Practice Address - Phone:423-283-4499
Practice Address - Fax:423-283-0336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU30844Medicare UPIN