Provider Demographics
NPI:1033517479
Name:THOMAS M DVORAKPC
Entity Type:Organization
Organization Name:THOMAS M DVORAKPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MERLE
Authorized Official - Last Name:DVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-876-2672
Mailing Address - Street 1:3434 TOWNE CROSSING BLVD
Mailing Address - Street 2:SUITE 112-B
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2782
Mailing Address - Country:US
Mailing Address - Phone:972-686-4738
Mailing Address - Fax:972-686-6490
Practice Address - Street 1:3434 TOWNE CROSSING BLVD
Practice Address - Street 2:SUITE 112-B
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2782
Practice Address - Country:US
Practice Address - Phone:972-686-4738
Practice Address - Fax:972-686-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3936T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty