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Contact Information

GARY A DORMAN
400 FAIRVIEW AVE
SUITE 21
PONCA CITY, OK74601-1922
 Phone: 580-765-3356
 Fax: 580-765-3353
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for GARY A DORMAN · (Male)

NPI # 1467444315
Status Active
Credentials
Entity Individual
Enumeration date 08/17/2005
Last updated 05/01/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • OK License # 1043
  • OK Medicaid 100764410A
  • OK Other 7311837180001 BLUE CROSS/BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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