Provider Demographics
NPI:1699728154
Name:DUNN & PAKULSKI OPTOMETRISTS
Entity type:Organization
Organization Name:DUNN & PAKULSKI OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:PAKULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:207-474-9613
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0608
Mailing Address - Country:US
Mailing Address - Phone:207-474-9613
Mailing Address - Fax:207-474-0849
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976
Practice Address - Country:US
Practice Address - Phone:207-474-9613
Practice Address - Fax:207-474-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME645TA152W00000X
ME671TA152W00000X
ME823TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME122670000Medicaid
ME0161280001Medicare NSC
MEMM6395Medicare PIN