Provider Demographics
NPI:1063547941
Name:THOMAS P. DUNNING O.D., P.C.
Entity type:Organization
Organization Name:THOMAS P. DUNNING O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-272-4740
Mailing Address - Street 1:335 BRIDGE ST NW
Mailing Address - Street 2:#806
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-8706
Mailing Address - Country:US
Mailing Address - Phone:616-272-4740
Mailing Address - Fax:616-272-4740
Practice Address - Street 1:335 BRIDGE ST NW
Practice Address - Street 2:#806
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-8706
Practice Address - Country:US
Practice Address - Phone:616-272-4740
Practice Address - Fax:616-272-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3513761Medicaid
MI900D167570OtherBCBS
MI3513761Medicaid
MIU24277Medicare UPIN