Provider Demographics
NPI:1821117805
Name:BUCK, DENNIS ORLA (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ORLA
Last Name:BUCK
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 1:1207 E MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1219
Mailing Address - Country:US
Mailing Address - Phone:602-971-9357
Mailing Address - Fax:
Practice Address - Street 1:9350 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1103
Practice Address - Country:US
Practice Address - Phone:623-877-3571
Practice Address - Fax:623-877-3769
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist