Provider Demographics
NPI:1417361601
Name:DUNN EYE ASSOCIATES OD PLLC
Entity Type:Organization
Organization Name:DUNN EYE ASSOCIATES OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/LEASE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DUNN
Authorized Official - Last Name:NIENABER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-793-5904
Mailing Address - Street 1:3732 CREEKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1363
Mailing Address - Country:US
Mailing Address - Phone:336-793-5904
Mailing Address - Fax:
Practice Address - Street 1:3732 CREEKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1363
Practice Address - Country:US
Practice Address - Phone:336-793-5904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093G1Medicaid
U86874Medicare UPIN
NC89093G1Medicaid