Provider Demographics
NPI:1972686525
Name:DUNN, JOHN JOESPH JR (RDO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOESPH
Last Name:DUNN
Suffix:JR
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MASSACHUSETTS AVE
Mailing Address - Street 2:UNIT 101B
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8448
Mailing Address - Country:US
Mailing Address - Phone:781-646-7776
Mailing Address - Fax:781-646-7784
Practice Address - Street 1:180 MASSACHUSETTS AVE
Practice Address - Street 2:UNIT 101B
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8448
Practice Address - Country:US
Practice Address - Phone:781-646-7776
Practice Address - Fax:781-646-7784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4134156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0602570001Medicare NSC