Provider Demographics
NPI:1467826768
Name:DUNNAVANT, JULIA (OD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DUNNAVANT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2825 W MAIN ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3927
Mailing Address - Country:US
Mailing Address - Phone:406-587-7050
Mailing Address - Fax:406-587-0525
Practice Address - Street 1:2825 W MAIN ST STE 1E
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3927
Practice Address - Country:US
Practice Address - Phone:406-587-7050
Practice Address - Fax:406-587-0525
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00661800152W00000X
MT3964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ30206012OtherDAVIS VISION