Provider Demographics
NPI:1659309177
Name:CASSIDY, DAWN RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:RENEE
Last Name:CASSIDY
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 1:141 SOUTHRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9491
Mailing Address - Country:US
Mailing Address - Phone:317-896-1326
Mailing Address - Fax:
Practice Address - Street 1:16865 CLOVER RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3640
Practice Address - Country:US
Practice Address - Phone:317-773-1981
Practice Address - Fax:317-773-1781
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003134A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN211460Medicare ID - Type Unspecified
INU97118Medicare UPIN