Provider Demographics
NPI:1235332081
Name:ROBERT S DOTSON, MD PC
Entity Type:Organization
Organization Name:ROBERT S DOTSON, MD PC
Other - Org Name:REFRACTIVE SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CDC
Authorized Official - Phone:865-986-3710
Mailing Address - Street 1:200 NEW YORK AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5212
Mailing Address - Country:US
Mailing Address - Phone:865-483-6399
Mailing Address - Fax:
Practice Address - Street 1:200 NEW YORK AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5212
Practice Address - Country:US
Practice Address - Phone:865-483-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3159190Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
TND70167Medicare UPIN
TN3717028Medicare ID - Type UnspecifiedMEDICARE GROUP