Provider Demographics
NPI:1013989292
Name:DOLAN, MICHAEL J (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:DOLAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4384 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9761
Mailing Address - Country:US
Mailing Address - Phone:585-243-2020
Mailing Address - Fax:585-243-1372
Practice Address - Street 1:4384 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9761
Practice Address - Country:US
Practice Address - Phone:585-243-2020
Practice Address - Fax:585-243-1372
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10005268OtherBCBS, BLUE CHOICE HMO
NY110414OtherEYEMED VISION
NY49847OtherDAVIS VISION
NY161457017OtherUNITED HEALTH CARE
NY5076330OtherAETNA
NY17009359OtherBLUE CHOICE HMO EYEWEAR
NY01529148Medicaid
NY410025041OtherMEDICARE RAIL ROAD
NY161457017OtherVISION SERVICE PLAN
NYMD462WOtherPREFERRED CARE
NY410025041OtherMEDICARE RAIL ROAD
NY17009359OtherBLUE CHOICE HMO EYEWEAR
NYMD462WOtherPREFERRED CARE