Provider Demographics
NPI:1437153814
Name:DAWSON, PATRICK R (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:DAWSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 WILLOW CHASE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-7720
Mailing Address - Country:US
Mailing Address - Phone:937-399-2519
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:45503-2652
Practice Address - Country:US
Practice Address - Phone:937-399-4101
Practice Address - Fax:937-399-2346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2260655Medicaid
OH260887OtherAETNA
OH000000338072OtherANTHEM
OH200806361029OtherCARESOURCE
OH2201865OtherUNITED HEALTH CARE
OHU84798Medicare UPIN
OH2260655Medicaid