Organization
TRAVIS B. BUNNELL, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS BRENTT BUNNELL O.D. (PRESIDENT)
(317) 485-5146
Entity
Organization
Contact information
Practice address
727 E BROADWAY ST, FORTVILLE, IN 46040-1551
(317) 485-5146
(317) 485-5147
Mailing address
PO BOX 100, FORTVILLE, IN 46040-0100
(317) 485-5146
(317) 485-5147
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200193350A
—
IN
05
—
200978610A
—
IN
01
—
410037718
RAILROAD MEDICARE
IN
Enumeration date
08/22/2005
Last updated
06/29/2010
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