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THOMAS B DUNHAM OD

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1568401107

Individual Registrant:
 THOMAS B DUNHAM OD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
109 S DUVAL ST  CLAXTON, GA 30417-2029 US
Tel: 912-739-4031  Fax: 912-739-0373

Contact information for business:
PO BOX 102635  ATLANTA, GA 30368-2635 US
Tel: 912-354-4800  Fax: 912-629-5821

Registration Information:
NPI: 1568401107
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
GA001527

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
MEDICAID - STATESBORO000707858FGA01
MEDICAID GRP. SAV.DAG976SC01
BLUE CROSS BLUE SHIELD67805601
DD0527SC05
MEDICAID- CLAXTON000707858EGA01
MEDICAID - STATESBORO000707858CGA01
MEDICARE RAILROAD1568401107GA01
GA MEDICARE GROUP511G701032GA01
00707858AGA05




HEALTH CARE JOBS GA - Page 1



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