Provider Demographics
NPI:1912129859
Name:GEORGE M DUNN JR OD PA
Entity type:Organization
Organization Name:GEORGE M DUNN JR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD PA
Authorized Official - Phone:870-673-1504
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-1011
Mailing Address - Country:US
Mailing Address - Phone:870-673-2959
Mailing Address - Fax:
Practice Address - Street 1:310 W 22ND ST STE 1
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-6652
Practice Address - Country:US
Practice Address - Phone:870-673-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2233302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111823722Medicaid
AR49759OtherBLUE CROSS
AR111823722Medicaid
AR0220670001Medicare NSC