Provider Demographics
NPI:1013397231
Name:DAU, MADELINE ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:ROSE
Last Name:DAU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:132 EVEREST LN STE 5
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4090
Mailing Address - Country:US
Mailing Address - Phone:402-540-0648
Mailing Address - Fax:888-972-2191
Practice Address - Street 1:132 EVEREST LN STE 5
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4090
Practice Address - Country:US
Practice Address - Phone:402-540-0648
Practice Address - Fax:888-972-2191
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015029700Medicaid