Provider Demographics
NPI:1720089758
Name:LUPINSKI, DAVID EUGENE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:LUPINSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12105 COPPER WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1756
Mailing Address - Country:US
Mailing Address - Phone:704-295-4444
Mailing Address - Fax:704-295-4443
Practice Address - Street 1:12105 COPPER WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1756
Practice Address - Country:US
Practice Address - Phone:704-295-4444
Practice Address - Fax:704-295-4443
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093JHMedicaid
NC89093JHMedicaid
NCU84688Medicare UPIN
NC2471814BMedicare PIN