Healthcare Provider Details

I. General information

NPI: 1114963683
Provider Name (Legal Business Name): MICHAEL T DORKOWSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 MADISON AVE
MEMPHIS TN
38104-2211
US

IV. Provider business mailing address

1245 MADISON AVE
MEMPHIS TN
38104-2211
US

V. Phone/Fax

Practice location:
  • Phone: 901-722-3250
  • Fax: 901-722-3347
Mailing address:
  • Phone: 901-722-3250
  • Fax: 901-722-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6633
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2542
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: