Provider Demographics
NPI:1295716116
Name:DUNN, THOMAS ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLEN
Last Name:DUNN
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 1:606 S GEORGE WALLACE DRIVE
Mailing Address - Street 2:PO DRAWER 728
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081
Mailing Address - Country:US
Mailing Address - Phone:334-566-2020
Mailing Address - Fax:334-566-2035
Practice Address - Street 1:606 S GEORGE WALLACE DRIVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081
Practice Address - Country:US
Practice Address - Phone:334-566-2020
Practice Address - Fax:334-566-2035
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL060156152W00000X
ALS558TA031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051507550OtherBLUE CROSS BLUE SHIELD
AL2210102OtherUNITED HEALTH CARE
AL051551494Medicaid
AL051507550OtherBLUE CROSS BLUE SHIELD
AL4571390001Medicare NSC
AL051551494Medicare PIN