Provider Demographics
NPI:1447563747
Name:DUNKER, STEPHANIE MARLENE (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARLENE
Last Name:DUNKER
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 1:24 WEBSTER PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7937
Mailing Address - Country:US
Mailing Address - Phone:617-202-2020
Mailing Address - Fax:617-734-3264
Practice Address - Street 1:24 WEBSTER PL
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7937
Practice Address - Country:US
Practice Address - Phone:617-202-2020
Practice Address - Fax:617-734-3264
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002341152W00000X
MA4807152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist