Provider Demographics
NPI:1851469456
Name:TUMINELLO, DAWN M (OD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:TUMINELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:WLODARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11319 W 143RD STREET
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7221
Mailing Address - Country:US
Mailing Address - Phone:708-460-2020
Mailing Address - Fax:708-460-2025
Practice Address - Street 1:11319 W 143RD STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7221
Practice Address - Country:US
Practice Address - Phone:708-460-2020
Practice Address - Fax:708-460-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633253OtherBCBS
K26765Medicare ID - Type Unspecified
IL1633253OtherBCBS