Provider Demographics
NPI:1215073614
Name:DOSIK, ALLAN GARY (OD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:GARY
Last Name:DOSIK
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 1:6200 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1110
Mailing Address - Country:US
Mailing Address - Phone:703-536-3663
Mailing Address - Fax:703-536-3663
Practice Address - Street 1:6795B SPRINGFIELD MALL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1704
Practice Address - Country:US
Practice Address - Phone:703-719-9198
Practice Address - Fax:703-719-9199
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9205888Medicaid