Provider Demographics
NPI:1841355799
Name:DODDS, DUANE E (OD)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:E
Last Name:DODDS
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 1:900 DANA DR
Mailing Address - Street 2:STE 5A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4053
Mailing Address - Country:US
Mailing Address - Phone:530-895-1649
Mailing Address - Fax:
Practice Address - Street 1:900 DANA DR
Practice Address - Street 2:MT SHASTA MALL
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4053
Practice Address - Country:US
Practice Address - Phone:530-221-6557
Practice Address - Fax:530-221-6593
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10230Medicare UPIN
CASD0060920Medicare ID - Type Unspecified