Provider Demographics
NPI:1871697235
Name:DUPREE, DAVID WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:DUPREE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 JONES RD
Mailing Address - Street 2:
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596-9523
Mailing Address - Country:US
Mailing Address - Phone:360-785-3948
Mailing Address - Fax:360-748-3911
Practice Address - Street 1:1601 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1700
Practice Address - Country:US
Practice Address - Phone:360-740-9562
Practice Address - Fax:360-748-3911
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3259TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB06554Medicare ID - Type Unspecified
U63291Medicare UPIN