Provider Demographics
NPI:1356404487
Name:DOTSON, GREGORY DUANE (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DUANE
Last Name:DOTSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 EMMETT ST W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2963
Mailing Address - Country:US
Mailing Address - Phone:269-966-2600
Mailing Address - Fax:
Practice Address - Street 1:181 EMMETT ST W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2963
Practice Address - Country:US
Practice Address - Phone:269-966-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003568152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901003568OtherSTATE LICENSE
MI944558060Medicaid
MIU49006Medicare UPIN