NPIMap

Organization Active NPI

Sunil Gupta MD LLC

  • Ophthalmology Physician
  • Crestview, FL
National Provider Identifier
1376110585
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SUNIL GUPTA MD LLC
Practice address
1299 Industrial Dr
Crestview, FL 32539-8946
Phone
(850) 634-4342
Fax
(850) 634-4353
NPI assigned
Jun 7, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

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

Authorized official

Name
Sunil Gupta, MD
Title
Managing Partner
Phone
(850) 476-6759

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207WX0107X

Addresses

Primary practice location

1299 Industrial Dr
Crestview, FL 32539-8946

Mailing address

5150 N Davis Hwy
Pensacola, FL 32503-2030
Phone (850) 476-6759

Other names 1

  • Retina Specialty Institute Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Retina Specialty Institute8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1376110585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032030",
            "telephone_number": "850-476-6759",
            "fax_number": "850-484-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 INDUSTRIAL DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325398946",
            "telephone_number": "850-634-4342",
            "fax_number": "850-634-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNIL GUPTA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-07",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "850-476-6759",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retina Specialty Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.