=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235899105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. BARBARA DUNE OD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2021
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 WOODLAND ST STE 21
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-216-3147
-----------------------------------------------------
Fax | 860-263-7580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 WOODLAND ST STE 21
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-216-3147
-----------------------------------------------------
Fax | 860-263-7580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BARBARA DUNE
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 860-263-8048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------