Provider Demographics
NPI:1023005170
Name:DAWSON, DAVID J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:DAWSON
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 1:137 EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2339
Mailing Address - Country:US
Mailing Address - Phone:330-630-2580
Mailing Address - Fax:234-542-1332
Practice Address - Street 1:137 EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2339
Practice Address - Country:US
Practice Address - Phone:330-630-2580
Practice Address - Fax:234-542-1332
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4830/T1695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2885847Medicaid
OHV04791Medicare UPIN
OH2885847Medicaid