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NPI Code Detail

MEDICARE: DR. THOMAS MERLE DVORAK O.D.

MEDICARE: DR. THOMAS MERLE DVORAK O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3936TTX

General Provider Information

NPI Number : 1598899379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MERLE DVORAK O.D.
Provider Business Mailing Address
First Line : 304 RIDGE POINT DR
Second Line :
City : FORNEY
State : TX
Zip : 75126-5354
Country : US
Telephone Number : 469-273-3348
Fax Number :
Provider Business Practice Location Address
First Line : 2703 RICHMOND RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-2328
Country : US
Telephone Number : 903-838-0783
Fax Number : 903-831-6145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 06/03/2019

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