Provider Demographics
NPI:1780794024
Name:JUPITER, DAVID GARY (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
Last Name:JUPITER
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 1:2500 GRUBB RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4799
Mailing Address - Country:US
Mailing Address - Phone:302-475-6500
Mailing Address - Fax:302-475-9528
Practice Address - Street 1:2500 GRUBB RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4799
Practice Address - Country:US
Practice Address - Phone:302-475-6500
Practice Address - Fax:302-475-9528
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE013516B86Medicare PIN
U47685Medicare UPIN