Provider Demographics
NPI:1568455921
Name:DUNN, VAN MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:MICHAEL
Last Name:DUNN
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-0037
Mailing Address - Country:US
Mailing Address - Phone:870-382-2394
Mailing Address - Fax:870-382-2395
Practice Address - Street 1:129 W WATERMAN ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2139
Practice Address - Country:US
Practice Address - Phone:870-382-2394
Practice Address - Fax:870-382-2395
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0367470001Medicare NSC
T20289Medicare UPIN
AR49198Medicare ID - Type Unspecified