Basic Information
| Provider Information | |||||||||
| NPI: | 1598899379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DVORAK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MERLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 RIDGE POINT DR | ||||||||
| Address2: | |||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751265354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692733348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2703 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755032328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038380783 | ||||||||
| FaxNumber: | 9038316145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3936T | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.