Healthcare Provider Details

I. General information

NPI: 1306943436
Provider Name (Legal Business Name): DUNES OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E COOLSPRING AVE
MICHIGAN CITY IN
46360-6312
US

IV. Provider business mailing address

PO BOX L
MICHIGAN CITY IN
46361-0310
US

V. Phone/Fax

Practice location:
  • Phone: 219-878-5021
  • Fax: 219-878-5002
Mailing address:
  • Phone: 219-878-5021
  • Fax: 219-878-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: HENRY BAUSBACK
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 219-878-5021