Provider Demographics
NPI:1457757429
Name:TORY L DOTSON OD PLLC
Entity Type:Organization
Organization Name:TORY L DOTSON OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-431-9939
Mailing Address - Street 1:105 MIMOSA LN
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5703
Mailing Address - Country:US
Mailing Address - Phone:918-431-9939
Mailing Address - Fax:918-431-9945
Practice Address - Street 1:105 MIMOSA LN
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5703
Practice Address - Country:US
Practice Address - Phone:918-431-9939
Practice Address - Fax:918-453-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200299660AMedicaid