Provider Demographics
NPI:1245191162
Name:DOTSON, HEATHER MARIE (ABO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:VA
Mailing Address - Zip Code:23149-2514
Mailing Address - Country:US
Mailing Address - Phone:804-693-2623
Mailing Address - Fax:804-693-8905
Practice Address - Street 1:6819 WALTONS LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-6113
Practice Address - Country:US
Practice Address - Phone:804-693-2623
Practice Address - Fax:804-693-8905
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004694156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician