Provider Demographics
NPI:1972934479
Name:DORSEY, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 3RD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 W 3RD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4667
Practice Address - Country:US
Practice Address - Phone:903-641-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR4133156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician