Provider Demographics
NPI:1679565105
Name:DUNAWAY, EDWIN (OD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:DUNAWAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-5901
Mailing Address - Country:US
Mailing Address - Phone:501-565-2848
Mailing Address - Fax:501-565-2724
Practice Address - Street 1:8801 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-5901
Practice Address - Country:US
Practice Address - Phone:501-565-2848
Practice Address - Fax:501-565-2724
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133103722Medicaid
AR133103722Medicaid
ART97974Medicare UPIN