Healthcare Provider Details

I. General information

NPI: 1841355799
Provider Name (Legal Business Name): DUANE E DODDS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 DANA DR MT SHASTA MALL
REDDING CA
96003-4053
US

IV. Provider business mailing address

900 DANA DR STE 5A
REDDING CA
96003-4053
US

V. Phone/Fax

Practice location:
  • Phone: 530-221-6557
  • Fax: 530-221-6593
Mailing address:
  • Phone: 530-895-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: