Provider Demographics
NPI:1295834935
Name:DUNLAP, THOMAS E JR (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:DUNLAP
Suffix:JR
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:PO BOX 1249
Mailing Address - Street 2:303 SALISBURY AVENUE
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002
Mailing Address - Country:US
Mailing Address - Phone:704-982-6011
Mailing Address - Fax:704-982-1106
Practice Address - Street 1:303 SALISBURY AVENUE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28002
Practice Address - Country:US
Practice Address - Phone:704-982-6011
Practice Address - Fax:704-982-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410003847OtherRAILROAD MEDICARE
NC89013HNMedicaid
NC0558150001OtherPALMETTO
NC8909247Medicaid
NC09247OtherBCBS ID NUMBER
NC013HNOtherBCBS GOUP NUMBER
NC09247OtherNC HEALTH CHOICE
NCT64982Medicare UPIN
NC0558150001OtherPALMETTO
NC2469041Medicare ID - Type UnspecifiedGROUP NUMBER
NC8909247Medicaid