Provider Demographics
NPI:1023069432
Name:DOLAN, JUDITH G (OD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:DOLAN
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 1:1100 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4853
Mailing Address - Country:US
Mailing Address - Phone:903-439-2020
Mailing Address - Fax:
Practice Address - Street 1:1100 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4853
Practice Address - Country:US
Practice Address - Phone:903-439-2020
Practice Address - Fax:903-439-4661
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3463TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154623601Medicaid
TX80629QOtherBLUECROSS BLUE SHIELD
TX410046771OtherRAIL ROAD MEDICARE
TX410046771OtherRAIL ROAD MEDICARE