Provider Demographics
NPI:1356074090
Name:UPTON, JAMES TREY
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TREY
Last Name:UPTON
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 1:3440 S NATIONAL AVE # 2020
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7307
Mailing Address - Country:US
Mailing Address - Phone:417-725-0500
Mailing Address - Fax:417-725-0502
Practice Address - Street 1:3440 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7307
Practice Address - Country:US
Practice Address - Phone:417-886-5444
Practice Address - Fax:417-725-0502
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2856152W00000X
MO2024017966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist