Healthcare Provider Details

I. General information

NPI: 1730158080
Provider Name (Legal Business Name): JEFFREY H DOTY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NATIONWIDE DR
LYNCHBURG VA
24502-4271
US

IV. Provider business mailing address

116 NATIONWIDE DR
LYNCHBURG VA
24502-4271
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3984
  • Fax:
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002914
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4188 T45
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: