Individual provider Active NPI

Eric Phillip Dupuis, O.D.

  • Optometrist
  • Davie, FL
National Provider Identifier
1336121086
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT2556 Issued in CO
Practice address
8165 SW 24TH St
Davie, FL 33324-5711
Phone
(954) 594-4483
NPI assigned
Nov 17, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT2556 CO Primary

Addresses

Primary practice location

8165 SW 24TH St
Davie, FL 33324-5711

Mailing address

1836 30TH St
Boulder, CO 80301-1016
Phone (954) 594-4483

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131230000842 CO Practitioner - Optometry 0648274696 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1836 30TH St
Boulder, CO 80301-1016
Phone (303) 449-2401

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT2556COMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dupuis Optometry, Inc. Single Specialty CurrentSince Aug 26, 2013 Accepting new patients
South Florida Vision Services, Inc. Optometrist PastSince Mar 11, 2017 Accepting new patients
Rabia Awan OD PA Optometrist Past Accepting new patients

Locations

1836 30th St
Boulder, CO 80301
Phone (303) 449-2401

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1336121086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 30TH ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011016",
            "telephone_number": "954-594-4483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8165 SW 24TH ST",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333245711",
            "telephone_number": "954-594-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPUIS",
        "first_name": "ERIC",
        "middle_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT2556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.