Provider Demographics
NPI:1598899379
Name:DVORAK, THOMAS MERLE (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MERLE
Last Name:DVORAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:304 RIDGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5354
Mailing Address - Country:US
Mailing Address - Phone:469-273-3348
Mailing Address - Fax:
Practice Address - Street 1:2703 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2328
Practice Address - Country:US
Practice Address - Phone:903-838-0783
Practice Address - Fax:903-831-6145
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3936T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist