Provider Demographics
NPI:1831401991
Name:DUNKIN, TINA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:DUNKIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1205
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:514 WARREN COUNTY CTR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-3023
Practice Address - Country:US
Practice Address - Phone:636-377-2054
Practice Address - Fax:636-377-2056
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5227032Medicare UPIN
MO145450009Medicare PIN
MOMA3216005Medicare PIN