Individual
DR. MICHAEL DEAN GUPTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
521 WEBSTER ST, SOUTH BOSTON, VA 24592-2429
(434) 374-2778
Mailing address
PO BOX 38, CLARKSVILLE, VA 23927-0038
(434) 374-2778
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000060
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9204202
—
VA
Enumeration date
10/05/2006
Last updated
01/23/2008
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