Provider Demographics
NPI:1790981710
Name:DIXON OPTOMETRIC CENTER, INC.
Entity Type:Organization
Organization Name:DIXON OPTOMETRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-284-2020
Mailing Address - Street 1:511 PALMYRA ST
Mailing Address - Street 2:P O BOX 344
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1953
Mailing Address - Country:US
Mailing Address - Phone:815-284-2020
Mailing Address - Fax:815-284-8326
Practice Address - Street 1:511 PALMYRA ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1953
Practice Address - Country:US
Practice Address - Phone:815-284-2020
Practice Address - Fax:815-284-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1144283821OtherDR. LAWLESS NPI
IL1790981710OtherCORPORATE NPI
ILT35324Medicare UPIN
IL910370Medicare ID - Type Unspecified
IL1790981710OtherCORPORATE NPI