Provider Demographics
NPI:1881847358
Name:DUNN, TAMARA L (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:L
Last Name:DUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:BALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2814 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1959
Mailing Address - Country:US
Mailing Address - Phone:810-275-3379
Mailing Address - Fax:
Practice Address - Street 1:3405 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3009
Practice Address - Country:US
Practice Address - Phone:810-732-4110
Practice Address - Fax:810-732-7574
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C317780OtherBLUE CROSS BLUE SHIELD
MI900C317780OtherBLUE CROSS BLUE SHIELD