Provider Demographics
NPI:1003803677
Name:DAWSON-CLAUSEN, LISA ANNE (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:DAWSON-CLAUSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:16250 DULUTH AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2883
Mailing Address - Country:US
Mailing Address - Phone:952-447-2020
Mailing Address - Fax:952-447-2322
Practice Address - Street 1:16250 DULUTH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2883
Practice Address - Country:US
Practice Address - Phone:952-447-2020
Practice Address - Fax:952-447-2322
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84698Medicare UPIN
410001630Medicare ID - Type Unspecified