Provider Demographics
NPI:1376574681
Name:BUNCH, JOE L (OD (OPTOMETRIST))
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:L
Last Name:BUNCH
Suffix:
Gender:M
Credentials:OD (OPTOMETRIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 14TH ST
Mailing Address - Street 2:#400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4423
Mailing Address - Country:US
Mailing Address - Phone:972-422-2020
Mailing Address - Fax:
Practice Address - Street 1:3200 14TH ST
Practice Address - Street 2:#400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4423
Practice Address - Country:US
Practice Address - Phone:972-422-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E12NMedicare ID - Type UnspecifiedMEDCARE #
TX1140290001Medicare NSC
TXU12063Medicare UPIN