Provider Demographics
NPI:1578687364
Name:BUNZ, DENNIS M
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:M
Last Name:BUNZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 UNION RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-5040
Mailing Address - Country:US
Mailing Address - Phone:716-632-0778
Mailing Address - Fax:716-634-2679
Practice Address - Street 1:4245 UNION RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5040
Practice Address - Country:US
Practice Address - Phone:716-632-0778
Practice Address - Fax:716-634-2679
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY3728156FC0800X, 156FC0801X, 156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00622082Medicaid
NY1532990001Medicare ID - Type UnspecifiedMEDICARE