=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326352998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WYMAN DOBBS OPTOMETRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2010
-----------------------------------------------------
Last Update Date | 04/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 W CHEROKEE AVE
-----------------------------------------------------
City | SALLISAW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74955-4213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-775-5529
-----------------------------------------------------
Fax | 918-775-0515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 W CHEROKEE AVE
-----------------------------------------------------
City | SALLISAW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74955-4213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-775-5529
-----------------------------------------------------
Fax | 918-775-0515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WYMAN D. DOBBS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 918-775-5529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1172
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------