Provider Demographics
NPI:1396701348
Name:DOLLAK, JOSEPH MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:DOLLAK
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 1:24914 KUYKENDAHL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3381
Mailing Address - Country:US
Mailing Address - Phone:936-499-9664
Mailing Address - Fax:281-516-3113
Practice Address - Street 1:24914 KUYKENDAHL RD
Practice Address - Street 2:STE D
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3381
Practice Address - Country:US
Practice Address - Phone:281-516-3111
Practice Address - Fax:281-516-3113
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5854TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7013647OtherAETNA
TX80712QOtherBCBS
TX9042577OtherCIGNA
TX038641902Medicaid
TX8741B7Medicare ID - Type Unspecified
TX9042577OtherCIGNA