Provider Demographics
NPI:1851487425
Name:ERTEL, DAWN A (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:A
Last Name:ERTEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:A GRAY
Other - Last Name:ERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16165 S. BRADLEY DR.
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-780-2742
Mailing Address - Fax:
Practice Address - Street 1:3465 NE RALPH POWELL RD.
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-524-7400
Practice Address - Fax:816-525-1700
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000793152W00000X
KS1731152W00000X
IN18002691A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150330AMedicare ID - Type UnspecifiedHASN'T BEEN USED IN 5 YRS
U52084Medicare UPIN