Provider Demographics
NPI:1356404248
Name:BIRCH, DAWN M (OD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:BIRCH
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1720 S MICHIGAN AVE
Mailing Address - Street 2:3302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1465
Mailing Address - Country:US
Mailing Address - Phone:773-343-7638
Mailing Address - Fax:312-641-5503
Practice Address - Street 1:6254 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4610
Practice Address - Country:US
Practice Address - Phone:773-581-1515
Practice Address - Fax:773-581-9663
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL046.007794152W00000X
IL46-007794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39046Medicare UPIN