Provider Demographics
NPI:1518053941
Name:DORMAN, ALICIA N (OD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:N
Last Name:DORMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PATERSON AVE
Mailing Address - Street 2:PO BOX 1220
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-785-3277
Mailing Address - Fax:973-812-1723
Practice Address - Street 1:245 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:973-785-3277
Practice Address - Fax:973-812-1723
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059358Medicaid
NJD0117799Medicare ID - Type Unspecified
NJ0059358Medicaid