Provider Demographics
NPI:1023271996
Name:DUNLAP, KEVIN L (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
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 1:1251 U S 31 NORTH
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4503
Mailing Address - Country:US
Mailing Address - Phone:317-882-1905
Mailing Address - Fax:317-882-1905
Practice Address - Street 1:1251 U S 31 NORTH
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4503
Practice Address - Country:US
Practice Address - Phone:317-882-1905
Practice Address - Fax:317-882-1905
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU18445Medicare UPIN