Basic Information
| Provider Information | |||||||||
| NPI: | 1558419259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEAN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760284583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172950186 | ||||||||
| FaxNumber: | 8172957505 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760284583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172950186 | ||||||||
| FaxNumber: | 8172957505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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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 | 2284 | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.