MEDICARE: JENNIFER DUNGAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046010092	IL

General Provider Information

NPI Number	:	1427212513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DUNGAN OD

Provider Business Mailing Address
First Line	:	2028 E RIVERSIDE BLVD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4804
Country	:	US
Telephone Number	:	815-708-8382
Fax Number	:	815-708-8370

Provider Business Practice Location Address
First Line	:	2028 E RIVERSIDE BLVD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4804
Country	:	US
Telephone Number	:	815-708-8382
Fax Number	:	815-708-8370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	09/28/2022

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