Healthcare Provider Details

I. General information

NPI: 1639456411
Provider Name (Legal Business Name): KATHERINE LORETTA MURPHY DUNNE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N VERMILION ST
DANVILLE IL
61832-3094
US

IV. Provider business mailing address

1104 N VERMILION ST
DANVILLE IL
61832-3094
US

V. Phone/Fax

Practice location:
  • Phone: 217-442-2631
  • Fax: 217-442-0119
Mailing address:
  • Phone: 217-442-2631
  • Fax: 217-442-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010470
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: