Provider Demographics
NPI:1710978465
Name:DUNLAP, ADAM DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:DUNLAP
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:PO BOX 63
Mailing Address - Street 2:US ROUTE 30
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-0063
Mailing Address - Country:US
Mailing Address - Phone:724-539-1900
Mailing Address - Fax:724-532-1464
Practice Address - Street 1:US ROUTE 30
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:724-539-1900
Practice Address - Fax:724-532-1464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01898505Medicaid
PA054357Medicare ID - Type Unspecified
PA01898505Medicaid