Provider Demographics
NPI:1780738658
Name:DUNN, DAXX D (OD)
Entity type:Individual
Prefix:DR
First Name:DAXX
Middle Name:D
Last Name:DUNN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4085 MALLORY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8290
Mailing Address - Country:US
Mailing Address - Phone:615-771-2550
Mailing Address - Fax:615-771-2099
Practice Address - Street 1:4085 MALLORY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8290
Practice Address - Country:US
Practice Address - Phone:615-771-2550
Practice Address - Fax:615-771-2099
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4043602OtherBLUE CROSS BLUE SHIELD ID
TNU89537Medicare UPIN
TN39451041Medicare PIN