Provider Demographics
NPI:1245468511
Name:DUNN OPTOMETRY
Entity type:Organization
Organization Name:DUNN OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LAREEN
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-275-3379
Mailing Address - Street 1:515 E REID RD APT 6
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1238
Mailing Address - Country:US
Mailing Address - Phone:810-275-3379
Mailing Address - Fax:517-482-0941
Practice Address - Street 1:2925 TOWNE CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-5650
Practice Address - Country:US
Practice Address - Phone:517-482-0752
Practice Address - Fax:517-482-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000020633OtherPHYSICIANS HEALTH PLAN
MI900C317780OtherBLUE CROSS BLUE SHIELD