Provider Demographics
NPI:1083730014
Name:STEVEN SCOTT DOBSON
Entity Type:Organization
Organization Name:STEVEN SCOTT DOBSON
Other - Org Name:DIMOND VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-349-6932
Mailing Address - Street 1:1000 E DIMOND BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2029
Mailing Address - Country:US
Mailing Address - Phone:907-349-6932
Mailing Address - Fax:907-349-6347
Practice Address - Street 1:1000 E DIMOND BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2029
Practice Address - Country:US
Practice Address - Phone:907-349-6932
Practice Address - Fax:907-349-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK94152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK0000WCKFSMedicare PIN
AK0807440001Medicare NSC