Individual
ELLIOTT STUPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4171 S TAMIAMI TR, #34, VENICE, FL 34293-2932
(941) 223-6381
Mailing address
6248 WEYMOUTH DR, SARASOTA, FL 34238-2763
(941) 889-6381
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 3404
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621028700
—
FL
Enumeration date
07/07/2006
Last updated
11/24/2008
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