Provider Demographics
NPI:1558419259
Name:DEAN, DENNIS M (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:DEAN
Suffix:
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 1:209 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4583
Mailing Address - Country:US
Mailing Address - Phone:817-295-0186
Mailing Address - Fax:817-295-7505
Practice Address - Street 1:209 MARKET STREET
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4583
Practice Address - Country:US
Practice Address - Phone:817-295-0186
Practice Address - Fax:817-295-7505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0692440001Medicare NSC
TX00E09AMedicare PIN
TXT12964Medicare UPIN