MEDICARE: VAN M DUNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	D12262	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366432551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN M DUNN

Provider Business Mailing Address
First Line	:	PO BOX 294
Second Line	:
City	:	DE WITT
State	:	AR
Zip	:	72042-0294
Country	:	US
Telephone Number	:	870-946-1716
Fax Number	:	870-946-1561

Provider Business Practice Location Address
First Line	:	1703 S WHITEHEAD DR
Second Line	:
City	:	DE WITT
State	:	AR
Zip	:	72042-2911
Country	:	US
Telephone Number	:	870-946-1716
Fax Number	:	870-946-1561

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SUE F CURRIE
Credential	:
Telephone Number	:	870-946-1716

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	06/09/2008

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Directions to “VAN M DUNN ” Practice Location

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