Basic Information
| Provider Information | |||||||||
| NPI: | 1023136934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THOMAS E. DUNLAP JR. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DUNLAP VISION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1249 | ||||||||
| Address2: | 303 SALISBURY AVE. | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280013359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049826011 | ||||||||
| FaxNumber: | 7049821106 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 SALISBURY AVE. | ||||||||
| Address2: | |||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280013359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049826011 | ||||||||
| FaxNumber: | 7049821106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 08/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | DUNLAP | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER-OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 7049826011 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NC1165 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 410003847 | 01 | NC | RR MEDICARE | OTHER | 8909247 | 05 | NC | MEDICAID |