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General NPI Number Information
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NPI Number | 1073647293
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Entity Type | Organization
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Legal Business Name | BRENT DUNLAP OD PC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 42 BRIARCLIFF PROFESSIONAL CENTER
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City | BOURBONNAIS
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State | IL
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Zip | 60914
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Country | US
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Telephone | 815-932-1116
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Fax | 815-932-9919
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Provider Business Mailing Address
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Address Line | 42 BRIARCLIFF PROFESSIONAL CENTER
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City | BOURBONNAIS
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State | IL
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Zip | 60914
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Country | US
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Telephone | 815-932-1116
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Fax | 815-932-9919
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT PATRICK DUNLAP
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Credential | O D
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Telephone | 815-932-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 469363
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License Number State | IL
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