MEDICARE: THOMAS STEPHEN DUNHAM O.D.

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	421	ND

General Provider Information

NPI Number	:	1982601357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS STEPHEN DUNHAM O.D.

Provider Business Mailing Address
First Line	:	PO BOX 365
Second Line	:
City	:	MCVILLE
State	:	ND
Zip	:	58254-0365
Country	:	US
Telephone Number	:	701-322-5111
Fax Number	:	701-322-5111

Provider Business Practice Location Address
First Line	:	1820 S 42ND ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5712
Country	:	US
Telephone Number	:	701-775-3151
Fax Number	:	701-775-3153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	11/21/2025

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