Provider Demographics
NPI:1225122823
Name:DODSON, CARL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DAVID
Last Name:DODSON
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 1:2008 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-454-8581
Mailing Address - Fax:740-454-8810
Practice Address - Street 1:2008 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2240
Practice Address - Country:US
Practice Address - Phone:740-454-8581
Practice Address - Fax:740-454-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260766Medicaid
OH000000120473OtherANTHEM BLUE CROSS BLUE SHIELD OF OHIO
OH0171770001OtherADMINASTAR/DMERC
OH580000506OtherMEDICARE-RAILROAD
OH000000120473OtherANTHEM BLUE CROSS BLUE SHIELD OF OHIO
OHT46712Medicare UPIN