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General NPI Number Information
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NPI Number | 1992797211
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Entity Type | Organization
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Legal Business Name | TRAVIS B. BUNNELL, O.D., P.C.
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 727 E BROADWAY ST
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City | FORTVILLE
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State | IN
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Zip | 46040-1551
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Country | US
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Telephone | 317-485-5146
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Fax | 317-485-5147
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | FORTVILLE
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State | IN
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Zip | 46040-0100
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Country | US
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Telephone | 317-485-5146
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Fax | 317-485-5147
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRAVIS BRENTT BUNNELL
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Credential | O.D.
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Telephone | 317-485-5146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 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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