Provider Demographics
NPI:1548202138
Name:DAWSON, CHRISTA DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:DAWN
Last Name:DAWSON
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 1:1024 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2456
Mailing Address - Country:US
Mailing Address - Phone:816-761-6337
Mailing Address - Fax:816-761-3564
Practice Address - Street 1:1024 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2456
Practice Address - Country:US
Practice Address - Phone:816-761-6337
Practice Address - Fax:816-761-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV08362Medicare UPIN
MOQ95E406Medicare ID - Type Unspecified