Provider Demographics
NPI:1629134820
Name:DUNN, CLIFFORD GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:GREGORY
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 1:43 OMEGA TER
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1957
Mailing Address - Country:US
Mailing Address - Phone:518-785-4424
Mailing Address - Fax:
Practice Address - Street 1:WAL MART VISION CENTER
Practice Address - Street 2:1549 ROUTE 9
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-5603
Practice Address - Country:US
Practice Address - Phone:518-373-5756
Practice Address - Fax:518-373-5759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005588152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC6613Medicare ID - Type Unspecified
NYU57320Medicare UPIN