Provider Demographics
NPI:1740324979
Name:DODD, DANIEL PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PAUL
Last Name:DODD
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 1:3333 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2050
Mailing Address - Country:US
Mailing Address - Phone:719-589-1500
Mailing Address - Fax:719-587-3809
Practice Address - Street 1:3333 CLARK ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2050
Practice Address - Country:US
Practice Address - Phone:719-589-1500
Practice Address - Fax:719-587-3809
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2186152W00000X
MT678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC448958OtherMEDICARE PTAN
CO14377276Medicaid
MT678OtherSTATE OF MONTANA
CO14377276Medicaid