Provider Demographics
NPI:1205947744
Name:DOLAN OPTICAL COMPANY
Entity type:Organization
Organization Name:DOLAN OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:586-776-3333
Mailing Address - Street 1:21527 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2209
Mailing Address - Country:US
Mailing Address - Phone:586-776-3333
Mailing Address - Fax:586-776-1713
Practice Address - Street 1:21527 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2209
Practice Address - Country:US
Practice Address - Phone:586-776-3333
Practice Address - Fax:586-776-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5015220Medicaid
MIOP0212OtherEYEMED
MI233011OtherNVA
MI233172OtherNVA
MI5015220Medicaid