Healthcare Provider Details

I. General information

NPI: 1366432551
Provider Name (Legal Business Name): VAN M DUNN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S WHITEHEAD DR
DE WITT AR
72042-2911
US

IV. Provider business mailing address

PO BOX 294
DE WITT AR
72042-0294
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-1716
  • Fax: 870-946-1561
Mailing address:
  • Phone: 870-946-1716
  • Fax: 870-946-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberD12262
License Number StateAR

VIII. Authorized Official

Name: MRS. SUE F CURRIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-946-1716