Healthcare Provider Details

I. General information

NPI: 1205947744
Provider Name (Legal Business Name): DOLAN OPTICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21527 HARPER AVE
SAINT CLAIR SHORES MI
48080-2209
US

IV. Provider business mailing address

21527 HARPER AVE
SAINT CLAIR SHORES MI
48080-2209
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-3333
  • Fax: 586-776-1713
Mailing address:
  • Phone: 586-776-3333
  • Fax: 586-776-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateMI

VIII. Authorized Official

Name: MICHAEL DOUGLAS DOLAN
Title or Position: OFFICER
Credential: OPTICIAN
Phone: 586-776-3333