Provider Demographics
NPI:1023136934
Name:THOMAS E. DUNLAP JR.
Entity type:Organization
Organization Name:THOMAS E. DUNLAP JR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:704-982-6011
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:303 SALISBURY AVE.
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3359
Mailing Address - Country:US
Mailing Address - Phone:704-982-6011
Mailing Address - Fax:704-982-1106
Practice Address - Street 1:303 SALISBURY AVE.
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3359
Practice Address - Country:US
Practice Address - Phone:704-982-6011
Practice Address - Fax:704-982-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410003847OtherRR MEDICARE
NC8909247Medicaid
T64982Medicare UPIN
NC246451AMedicare ID - Type Unspecified
NC8909247Medicaid