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General NPI Number Information
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NPI Number | 1033517479
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Entity Type | Organization
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Legal Business Name | THOMAS M DVORAKPC
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 3434 TOWNE CROSSING BLVD SUITE 112-B
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City | MESQUITE
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State | TX
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Zip | 75150-2782
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Country | US
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Telephone | 972-686-4738
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Fax | 972-686-6490
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Provider Business Mailing Address
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Address Line | 3434 TOWNE CROSSING BLVD SUITE 112-B
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City | MESQUITE
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State | TX
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Zip | 75150-2782
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Country | US
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Telephone | 972-686-4738
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Fax | 972-686-6490
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. THOMAS MERLE DVORAK
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Credential | OD
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Telephone | 214-876-2672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3936T
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License Number State | TX
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