Provider Demographics
NPI:1497868210
Name:DASHER, KURT LEE (O D)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:LEE
Last Name:DASHER
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11587 JENNINGS DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9732
Mailing Address - Country:US
Mailing Address - Phone:734-854-7280
Mailing Address - Fax:
Practice Address - Street 1:2155 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-8947
Practice Address - Country:US
Practice Address - Phone:734-242-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04507OtherPARAMOUNT