Provider Demographics
NPI:1821258104
Name:DAWN WATTENHOFER
Entity Type:Organization
Organization Name:DAWN WATTENHOFER
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATTENHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-343-1200
Mailing Address - Street 1:2200 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7854
Mailing Address - Country:US
Mailing Address - Phone:605-343-1200
Mailing Address - Fax:605-343-9752
Practice Address - Street 1:2200 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7854
Practice Address - Country:US
Practice Address - Phone:605-343-1200
Practice Address - Fax:605-343-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS6986Medicare PIN
SDS6984Medicare PIN
SDU72814Medicare UPIN
SDS6985Medicare PIN