Provider Demographics
NPI:1366432551
Name:VAN M DUNN
Entity type:Organization
Organization Name:VAN M DUNN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CURRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-946-1716
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0294
Mailing Address - Country:US
Mailing Address - Phone:870-946-1716
Mailing Address - Fax:870-946-1561
Practice Address - Street 1:1703 S WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2911
Practice Address - Country:US
Practice Address - Phone:870-946-1716
Practice Address - Fax:870-946-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARD12262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100926722Medicaid
ART20289Medicare UPIN
AR100926722Medicaid
AR0367470002Medicare NSC