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General NPI Number Information
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NPI Number | 1699958108
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Entity Type | Organization
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Legal Business Name | DORLON OPTICAL LLC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 1077 BRANSON HILLS PKWY SUITE N
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City | BRANSON
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State | MO
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Zip | 65616-9940
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Country | US
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Telephone | 417-336-1801
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Fax | 417-336-1803
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Provider Business Mailing Address
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Address Line | 1077 BRANSON HILLS PKWY SUITE N
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City | BRANSON
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State | MO
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Zip | 65616-9940
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Country | US
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Telephone | 417-336-1801
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Fax | 417-336-1803
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. SHANNA DORLON
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Credential |
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Telephone | 417-336-1801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 19975741
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License Number State | MO
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