Provider Demographics
NPI:1003827528
Name:DOLAN, DAVID BRANDON (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRANDON
Last Name:DOLAN
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 1:48821 MEADOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2531
Mailing Address - Country:US
Mailing Address - Phone:586-907-0600
Mailing Address - Fax:
Practice Address - Street 1:48856 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-2563
Practice Address - Country:US
Practice Address - Phone:586-323-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist