Provider Demographics
NPI:1558418970
Name:NEGRE, DAWN R (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:NEGRE
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 1:320 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1569
Practice Address - Country:US
Practice Address - Phone:417-678-1177
Practice Address - Fax:417-678-5954
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO314723206Medicaid
MA2696001Medicare PIN
350049029Medicare PIN
1288860001Medicare NSC
MOU76143Medicare UPIN