Provider Demographics
NPI:1700824208
Name:DUNN, CAMILLA JAYE (OD)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:JAYE
Last Name:DUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14410 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3237
Mailing Address - Country:US
Mailing Address - Phone:772-589-8111
Mailing Address - Fax:772-589-7561
Practice Address - Street 1:14410 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3237
Practice Address - Country:US
Practice Address - Phone:772-589-8111
Practice Address - Fax:772-589-7561
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20986OtherBCBS OF FL
FL620809600Medicaid
FLE6412WMedicare PIN
FL20986OtherBCBS OF FL
FL620809600Medicaid