Provider Demographics
NPI:1467511626
Name:DOTHAN OPHTHALMOLOGY
Entity Type:Organization
Organization Name:DOTHAN OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUGG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-1070
Mailing Address - Street 1:1750 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1318
Mailing Address - Country:US
Mailing Address - Phone:334-793-1070
Mailing Address - Fax:334-793-5114
Practice Address - Street 1:1750 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1318
Practice Address - Country:US
Practice Address - Phone:334-793-1070
Practice Address - Fax:334-793-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25880207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521882OtherBCBS
AL051554697Medicaid
AL529920110Medicaid
ALH96752Medicare UPIN