NPIMap

Organization Active NPI

Brent Dunlap OD PC

  • Optometrist
  • Bourbonnais, IL
National Provider Identifier
1073647293
Registry record updated Mar 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
469363 Issued in IL
Legal business name
BRENT DUNLAP OD PC
Practice address
42 Briarcliff Professional Center
Bourbonnais, IL 60914
Phone
(815) 932-1116
Fax
(815) 932-9919
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brent Patrick Dunlap, O DNPI 1760557698
Title
Owner
Phone
(815) 932-1116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 469363 IL Primary

Addresses

Primary practice location

42 Briarcliff Professional Center
Bourbonnais, IL 60914

Mailing address

42 Briarcliff Professional Center
Bourbonnais, IL 60914
Phone (815) 932-1116

Other names 1

  • DRS LONG & DUNLAP Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051013000920 IL Part B Supplier - Clinic/Group Practice 4183649510 Receives reassigned benefits from 4 practitioners
Practice locations: Bourbonnais, IL

National Provider Directory

National Provider Directory

Locations

719 Almar Pkwy
Bourbonnais, IL 60914
Phone (815) 932-1116

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206489600000",
    "number": "1073647293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 BRIARCLIFF PROFESSIONAL CENTER",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-932-1116",
            "fax_number": "815-932-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 BRIARCLIFF PROFESSIONAL CENTER",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-932-1116",
            "fax_number": "815-932-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT DUNLAP OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2008-03-26",
        "status": "A",
        "authorized_official_last_name": "DUNLAP",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-932-1116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "469363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DRS LONG & DUNLAP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.