Provider Demographics
NPI:1164646329
Name:PATRICK DAWSON LLC
Entity Type:Organization
Organization Name:PATRICK DAWSON LLC
Other - Org Name:THE EYE SITE OF SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-399-4101
Mailing Address - Street 1:1674 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-399-4101
Mailing Address - Fax:937-399-2346
Practice Address - Street 1:1674 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-399-4101
Practice Address - Fax:937-399-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4831152W00000X
OH2961152W00000X
OH4550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4550OtherLICENSE
OH029665Medicaid
OH0995240Medicaid
OH2478993Medicaid
OHT1293OtherLICENSE
OHT617OtherLICENSE
OH4831OtherLICENSE
OH2260655Medicaid
OH2961OtherLICENSE
OHT1696OtherLICENSE
OH0995240Medicaid
OH2260655Medicaid
OHT1293OtherLICENSE
OHU51925Medicare UPIN
OHU84798Medicare UPIN
OHCO0772463Medicare ID - Type Unspecified
OH4831OtherLICENSE