Active NPI
Michael Dean Gupton, O.D.
- Optometrist
- South Boston, VA
National Provider Identifier
1740376565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618000060
- Practice address
- 521 Webster St
South Boston, VA 24592-2429 - Phone
- (434) 374-2778
- NPI assigned
- Oct 5, 2006
- Last updated
- Jan 23, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618000060 | VA | Primary |
Addresses
Primary practice location
521 Webster St
South Boston, VA 24592-2429
Mailing address
PO Box 38
Clarksville, VA 23927-0038
Phone (434) 374-2778
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9204202 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201046400000",
"number": "1740376565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 38",
"city": "CLARKSVILLE",
"state": "VA",
"postal_code": "239270038",
"telephone_number": "434-374-2778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "521 WEBSTER ST",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "245922429",
"telephone_number": "434-374-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTON",
"first_name": "MICHAEL",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2008-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618000060",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9204202",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Boston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.