Healthcare Provider Details

I. General information

NPI: 1629186317
Provider Name (Legal Business Name): RANDALL W DOTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S 70TH ST SUITE 200
LINCOLN NE
68510-4278
US

IV. Provider business mailing address

1101 SOUTH 70TH ST SUITE 200
LINCOLN NE
68510
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-3132
  • Fax: 402-486-3187
Mailing address:
  • Phone: 402-486-3132
  • Fax: 402-486-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14449
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: