Provider Demographics
NPI:1962499251
Name:DUNCAN, DENNIS H (OD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:H
Last Name:DUNCAN
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 1:364 E ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3154
Mailing Address - Country:US
Mailing Address - Phone:626-331-6448
Mailing Address - Fax:626-967-7006
Practice Address - Street 1:364 E ROWLAND ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3154
Practice Address - Country:US
Practice Address - Phone:626-331-6448
Practice Address - Fax:626-967-7006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6902T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T70153Medicare UPIN
WOP6902AMedicare ID - Type Unspecified