Provider Demographics
NPI:1659567139
Name:DUNLAP EYE CLINIC, INC.
Entity Type:Organization
Organization Name:DUNLAP EYE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:O
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-665-5450
Mailing Address - Street 1:204 S WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1937
Mailing Address - Country:US
Mailing Address - Phone:260-665-5450
Mailing Address - Fax:260-665-5860
Practice Address - Street 1:204 S WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1937
Practice Address - Country:US
Practice Address - Phone:260-665-5450
Practice Address - Fax:260-665-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0632950001Medicare NSC