Healthcare Provider Details

I. General information

NPI: 1912129859
Provider Name (Legal Business Name): GEORGE M DUNN JR OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W 22ND ST STE 1
STUTTGART AR
72160-6652
US

IV. Provider business mailing address

PO BOX 1128
STUTTGART AR
72160-1011
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-2959
  • Fax:
Mailing address:
  • Phone: 870-673-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2233
License Number StateAR

VIII. Authorized Official

Name: GEORGE M. DUNN JR.
Title or Position: OPTOMETRIC PHYSICIAN
Credential: OD PA
Phone: 870-673-1504