=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245468511
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUNN OPTOMETRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2009
-----------------------------------------------------
Last Update Date | 09/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2925 TOWNE CENTRE BLVD
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48912-5650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-482-0752
-----------------------------------------------------
Fax | 517-482-0941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 E REID RD APT 6
-----------------------------------------------------
City | GRAND BLANC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48439-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-275-3379
-----------------------------------------------------
Fax | 517-482-0941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. TAMARA LAREEN DUNN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 810-275-3379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901004501
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------