Organization
GARY A DORMAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY DORMAN (OWNER)
(580) 765-3356
Entity
Organization
Contact information
Practice address
400 FAIRVIEW, SUITE 21, PONCA CITY, OK 74601-1922
(580) 765-3356
(580) 765-3353
Mailing address
400 FAIRVIEW, SUITE 21, PONCA CITY, OK 74601-1922
(580) 765-3356
(580) 765-3353
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1043
OK
Other
Enumeration date
01/23/2008
Last updated
11/04/2014
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