Provider Demographics
NPI:1568649275
Name:DAWN T VAN O D P A
Entity Type:Organization
Organization Name:DAWN T VAN O D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:954-437-8777
Mailing Address - Street 1:151 SW 184TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5465
Mailing Address - Country:US
Mailing Address - Phone:954-437-8777
Mailing Address - Fax:954-442-6524
Practice Address - Street 1:151 SW 184TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-5465
Practice Address - Country:US
Practice Address - Phone:954-437-8777
Practice Address - Fax:954-442-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8896Medicare PIN