Individual
MR. THOMAS WAYNE DOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO
Contact information
Practice address
623 N MAIN ST, ORANGE, CA 92868-1103
(714) 937-1998
(714) 937-1994
Mailing address
623 N MAIN ST, ORANGE, CA 92868-1103
(714) 937-1998
(714) 937-1994
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CO001146
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200114
CMS NUMBER
CA
01
—
XA0011460
MEDI-CAL PROVIDER#
CA
Enumeration date
07/31/2009
Last updated
03/10/2014
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