Provider Demographics
NPI:1659439958
Name:BOHNERT, DAWN L (OD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:L
Last Name:BOHNERT
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 1:106 LEGACY PLAZA WEST
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350
Mailing Address - Country:US
Mailing Address - Phone:219-362-2685
Mailing Address - Fax:219-362-5587
Practice Address - Street 1:106 LEGACY PLAZA WEST
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-362-2685
Practice Address - Fax:219-362-5587
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU64094Medicare UPIN
IN0525800001Medicare NSC
IN489780DMedicare PIN