Provider Demographics
NPI:1699762138
Name:DODSON, MARC H (OD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:H
Last Name:DODSON
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 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-994-1400
Mailing Address - Fax:508-910-2212
Practice Address - Street 1:51 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3319
Practice Address - Country:US
Practice Address - Phone:508-994-1400
Practice Address - Fax:508-910-2212
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353043Medicaid
MAW16157OtherB/C B/S OF MASS
MAU28035Medicare UPIN
MA453458Medicare PIN
MAW16157OtherB/C B/S OF MASS