Individual
THOMAS B DUNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
109 S DUVAL ST, CLAXTON, GA 30417-2029
(912) 739-4031
(912) 739-0373
Mailing address
PO BOX 102635, ATLANTA, GA 30368-2635
(912) 354-4800
(912) 629-5821
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
001527
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000707858C
MEDICAID - STATESBORO
GA
01
—
000707858E
MEDICAID- CLAXTON
GA
01
—
000707858F
MEDICAID - STATESBORO
GA
05
—
00707858A
—
GA
01
—
1568401107
MEDICARE RAILROAD
GA
01
—
511G701032
GA MEDICARE GROUP
GA
01
—
678056
BLUE CROSS BLUE SHIELD
—
01
—
DAG976
MEDICAID GRP. SAV.
SC
05
—
DD0527
—
SC
Enumeration date
06/06/2006
Last updated
04/09/2010
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