Provider Demographics
NPI:1972676138
Name:DUPPSTADT, ARTHUR O (OD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:O
Last Name:DUPPSTADT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1345
Mailing Address - Country:US
Mailing Address - Phone:724-845-7777
Mailing Address - Fax:724-845-3252
Practice Address - Street 1:84 2ND ST
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-1345
Practice Address - Country:US
Practice Address - Phone:724-845-7777
Practice Address - Fax:724-845-3252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001011ZDJ0OtherMEDICARE PTAN
PA1026200260001Medicaid
PAOEG001288OtherOPTOMETRIC LICENSE
001965801OtherHIGHMARK PROVIDER NUMBER
1518161413OtherNPI TYPE 2
PA1026200260001Medicaid
1518161413OtherNPI TYPE 2
PA0651900001Medicare NSC