Basic Information
| Provider Information | |||||||||
| NPI: | 1295834935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1249 | ||||||||
| Address2: | 303 SALISBURY AVENUE | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049826011 | ||||||||
| FaxNumber: | 7049821106 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 SALISBURY AVENUE | ||||||||
| Address2: | |||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049826011 | ||||||||
| FaxNumber: | 7049821106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NC1165 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 410003847 | 01 | NC | RAILROAD MEDICARE | OTHER | 89013HN | 05 | NC | MEDICAID | 0558150001 | 01 | NC | PALMETTO | OTHER | 8909247 | 05 | NC | MEDICAID | 09247 | 01 | NC | BCBS ID NUMBER | OTHER | 013HN | 01 | NC | BCBS GOUP NUMBER | OTHER | 09247 | 01 | NC | NC HEALTH CHOICE | OTHER |