Provider Demographics
NPI:1962545608
Name:UPTON, DONALD GLYN (O D)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GLYN
Last Name:UPTON
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2762
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39704-2762
Mailing Address - Country:US
Mailing Address - Phone:662-329-1233
Mailing Address - Fax:662-329-1255
Practice Address - Street 1:110A ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5221
Practice Address - Country:US
Practice Address - Phone:662-329-1233
Practice Address - Fax:662-329-1255
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0087920Medicaid
MS0087920Medicaid
MST21058Medicare UPIN