Provider Demographics
NPI:1245585272
Name:DAWSON, SARA B (OD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:DAWSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:108 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-3106
Mailing Address - Country:US
Mailing Address - Phone:212-647-1550
Mailing Address - Fax:
Practice Address - Street 1:108 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3106
Practice Address - Country:US
Practice Address - Phone:212-647-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist