Provider Demographics
NPI:1992282206
Name:DOTSON, JARRETT WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:JARRETT
Middle Name:WAYNE
Last Name:DOTSON
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 1:2019 COUGAR RUN CT SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2797
Mailing Address - Country:US
Mailing Address - Phone:505-660-9112
Mailing Address - Fax:
Practice Address - Street 1:5700 SAN ANTONIO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4178
Practice Address - Country:US
Practice Address - Phone:505-247-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOPT708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty