Provider Demographics
NPI:1174510069
Name:KAZMIERZAK, DAWN E (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:E
Last Name:KAZMIERZAK
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 1:980 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-1316
Mailing Address - Country:US
Mailing Address - Phone:260-824-2020
Mailing Address - Fax:260-824-4121
Practice Address - Street 1:980 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1316
Practice Address - Country:US
Practice Address - Phone:260-824-2020
Practice Address - Fax:260-824-4121
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002324A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN001OtherDAVIS VISION
IN000000200261OtherANTHEM BCBS
IN0356760001OtherDMERC
IN000000200261OtherANTHEM BCBS
IN227810BMedicare ID - Type Unspecified