Provider Demographics
NPI:1801947395
Name:DEPUGH, DAVID L (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:DEPUGH
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 GLEIM RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8322
Mailing Address - Country:US
Mailing Address - Phone:740-574-6477
Mailing Address - Fax:740-574-6070
Practice Address - Street 1:4010 RHODES AVE
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5557
Practice Address - Country:US
Practice Address - Phone:740-456-4143
Practice Address - Fax:740-456-6070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3664T908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795028Medicaid
410014461Medicare PIN
OHU19467Medicare UPIN
0669572Medicare PIN