Provider Demographics
NPI:1114975083
Name:WILCZEK, DAWN DACHELET (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:DACHELET
Last Name:WILCZEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:DACHELET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0697
Mailing Address - Country:US
Mailing Address - Phone:256-236-0300
Mailing Address - Fax:256-236-0324
Practice Address - Street 1:1105 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4657
Practice Address - Country:US
Practice Address - Phone:256-236-0300
Practice Address - Fax:256-236-0324
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A59-TA-624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517771OtherBCBS OF ALABAMA
AL051554101Medicaid
ALU96379Medicare UPIN
AL051554101Medicare PIN
AL51517771OtherBCBS OF ALABAMA