Provider Demographics
NPI:1164427225
Name:DAWSON, LINDA BRASSIL (OD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BRASSIL
Last Name:DAWSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5081 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8001
Mailing Address - Country:US
Mailing Address - Phone:614-478-8534
Mailing Address - Fax:614-478-8507
Practice Address - Street 1:5081 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-8001
Practice Address - Country:US
Practice Address - Phone:614-478-8534
Practice Address - Fax:614-478-8507
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA0842813Medicare ID - Type Unspecified
OHU69506Medicare UPIN
OHCH9352261Medicare ID - Type UnspecifiedGROUP