Provider Demographics
NPI:1982719688
Name:DOBBS, WYMAN DANE (OD)
Entity type:Individual
Prefix:DR
First Name:WYMAN
Middle Name:DANE
Last Name:DOBBS
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 1:603 W CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4213
Mailing Address - Country:US
Mailing Address - Phone:918-775-5529
Mailing Address - Fax:918-775-0515
Practice Address - Street 1:603 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4213
Practice Address - Country:US
Practice Address - Phone:918-775-5529
Practice Address - Fax:918-775-0515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKA101564OtherMEDICARE IND PTAN
OK100764610AMedicaid