Provider Demographics
NPI:1437245750
Name:DOBBS EYE CLINIC, INC.
Entity Type:Organization
Organization Name:DOBBS EYE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:ZANE
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-775-5529
Mailing Address - Street 1:603 W CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4213
Mailing Address - Country:US
Mailing Address - Phone:918-775-5529
Mailing Address - Fax:918-775-0515
Practice Address - Street 1:603 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4213
Practice Address - Country:US
Practice Address - Phone:918-775-5529
Practice Address - Fax:918-775-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522336Medicare PIN
OKT40420Medicare UPIN
OKT86466Medicare UPIN
OK5426190001Medicare NSC