Provider Demographics
NPI:1295465359
Name:RELIFORD, DAWN LASHAYE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:LASHAYE
Last Name:RELIFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 BURKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-5534
Mailing Address - Country:US
Mailing Address - Phone:270-384-0476
Mailing Address - Fax:270-384-0496
Practice Address - Street 1:2988 BURKESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-5534
Practice Address - Country:US
Practice Address - Phone:270-384-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111875156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician