=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699940437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA A. DORSEY, O.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2008
-----------------------------------------------------
Last Update Date | 04/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 827 COMMERCIAL ST
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-6282
-----------------------------------------------------
Fax | 620-342-5098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 827 COMMERCIAL ST
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-6282
-----------------------------------------------------
Fax | 620-342-5098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/PRESIDENT
-----------------------------------------------------
Name | DR. PATRICIA A. DORSEY
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 620-342-6282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1278-3
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------