Provider Demographics
NPI:1811973779
Name:DUNN, GEORGE M JR (OD PA)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:DUNN
Suffix:JR
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WEST 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160
Mailing Address - Country:US
Mailing Address - Phone:870-673-1504
Mailing Address - Fax:870-673-2959
Practice Address - Street 1:310 WEST 22ND STREET
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160
Practice Address - Country:US
Practice Address - Phone:870-673-1504
Practice Address - Fax:870-673-2959
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49759OtherBLUE CROSS
AR111823722Medicaid
ART20337Medicare UPIN