Provider Demographics
NPI:1073782199
Name:DODDS EYECARE, PLC
Entity Type:Organization
Organization Name:DODDS EYECARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-627-1100
Mailing Address - Street 1:631 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1438
Mailing Address - Country:US
Mailing Address - Phone:731-627-1100
Mailing Address - Fax:
Practice Address - Street 1:631 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059-1438
Practice Address - Country:US
Practice Address - Phone:731-627-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2268152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103G704082OtherMEDICARE PIN
103G704082OtherMEDICARE PIN