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General NPI Number Information
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NPI Number | 1134745748
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Entity Type | Organization
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Legal Business Name | BUCK I DUNN OD PA
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 4125 CLEVELAND AVE STE 35
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City | FORT MYERS
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State | FL
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Zip | 33901-9046
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Country | US
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Telephone | 239-936-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 16058 VIA SOLERA CIR APT 102
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City | FORT MYERS
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State | FL
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Zip | 33908-3782
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BUCK DUNN
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Credential | OD
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Telephone | 412-913-4303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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