Provider Demographics
NPI:1619925799
Name:DUNN, PETER K (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:K
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 1:306 MUIRS CHAPEL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6177
Mailing Address - Country:US
Mailing Address - Phone:336-854-0066
Mailing Address - Fax:336-252-1053
Practice Address - Street 1:306 MUIRS CHAPEL ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6117
Practice Address - Country:US
Practice Address - Phone:336-854-0066
Practice Address - Fax:336-252-1053
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09244OtherBLUE CROSS BLUE SHIELD
NC7909244Medicaid
NC246639AOtherMEDICARE PTAN
NC3368540066OtherVISION SERVICE PLAN
NC246639AOtherMEDICARE PTAN