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General NPI Number Information
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NPI Number | 1497759229
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Entity Type | Individual
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Provider Name | ROBERT F DUNDERVILL III M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 331 LAIDLEY ST STE 301
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City | CHARLESTON
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State | WV
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Zip | 25301-1605
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Country | US
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Telephone | 304-346-4400
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Fax | 304-346-0704
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Provider Business Mailing Address
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Address Line | PO BOX 3970
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City | CHARLESTON
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State | WV
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Zip | 25339-3970
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Country | US
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Telephone | 304-346-4400
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Fax | 304-346-0704
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 30257
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 35094593
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18154
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 18154
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License Number State | WV
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