Provider Demographics
NPI:1396887550
Name:CARL DAVID DODSON
Entity type:Organization
Organization Name:CARL DAVID DODSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-454-8581
Mailing Address - Street 1:2008 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2240
Mailing Address - Country:US
Mailing Address - Phone:740-454-8581
Mailing Address - Fax:740-454-8810
Practice Address - Street 1:2008 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2240
Practice Address - Country:US
Practice Address - Phone:740-454-8581
Practice Address - Fax:740-454-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3066332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2266819Medicaid
OH2266819Medicaid
OHCA9279981Medicare ID - Type Unspecified