Provider Demographics
NPI:1629186317
Name:DOTSON, RANDALL W (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:W
Last Name:DOTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SOUTH 70TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-486-3132
Mailing Address - Fax:402-486-3187
Practice Address - Street 1:1101 S 70TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4278
Practice Address - Country:US
Practice Address - Phone:402-486-3132
Practice Address - Fax:402-486-3187
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14449207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064735700Medicaid
D05108Medicare UPIN
274040Medicare ID - Type Unspecified