Provider Demographics
NPI:1558301283
Name:DUNLAP, RENEE T (OD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:T
Last Name:DUNLAP
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 1:21019 US HIGHWAY 281 N
Mailing Address - Street 2:SUITE 832
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7601
Mailing Address - Country:US
Mailing Address - Phone:210-490-3937
Mailing Address - Fax:210-490-3931
Practice Address - Street 1:21019 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 832
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7601
Practice Address - Country:US
Practice Address - Phone:210-490-3937
Practice Address - Fax:210-490-3931
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7303TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02359Medicare UPIN
L90835Medicare ID - Type Unspecified