Provider Demographics
NPI:1851607758
Name:BEARDEN, DAWN (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BEARDEN
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 1:209 N FORT LAUDERDALE BEACH BLVD
Mailing Address - Street 2:11G
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-4365
Mailing Address - Country:US
Mailing Address - Phone:954-303-6600
Mailing Address - Fax:
Practice Address - Street 1:1567 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2686
Practice Address - Country:US
Practice Address - Phone:954-763-2842
Practice Address - Fax:954-763-2850
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEM324ZMedicare PIN