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General NPI Number Information
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NPI Number | 1306943436
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Entity Type | Organization
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Legal Business Name | DUNES OPTICAL, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 1225 E COOLSPRING AVE
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-6312
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Country | US
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Telephone | 219-878-5021
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Fax | 219-878-5002
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Provider Business Mailing Address
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Address Line | PO BOX L
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City | MICHIGAN CITY
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State | IN
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Zip | 46361-0310
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Country | US
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Telephone | 219-878-5021
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Fax | 219-878-5002
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | HENRY BAUSBACK
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Credential | O.D.
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Telephone | 219-878-5021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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