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General NPI Number Information
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NPI Number | 1548345663
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Entity Type | Individual
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Provider Name | DREW DORAN DOUGLAS O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 4524 S BROADWAY AVE
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City | TYLER
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State | TX
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Zip | 75703-1305
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Country | US
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Telephone | 903-581-1530
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Fax | 903-534-8629
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5114
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License Number State | TX
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