Provider Demographics
NPI:1073180956
Name:BUNN, CARLI ANNE (OD)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:ANNE
Last Name:BUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NW CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3568
Mailing Address - Country:US
Mailing Address - Phone:541-752-4622
Mailing Address - Fax:
Practice Address - Street 1:2400 NW CENTURY DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3568
Practice Address - Country:US
Practice Address - Phone:541-752-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist