Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901004391 | MI |
NPI | 1003827528 |
---|---|
Provider Name | Dr. David Brandon Dolan |
First Address | Shelby Township, MI 48317-2531 |
Second Address | Shelby Township, MI 48317-2563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |