Provider Demographics
NPI:1700960291
Name:DAW, JOHN C (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:DAW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1260 S HOVER ST
Mailing Address - Street 2:STE. E
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7911
Mailing Address - Country:US
Mailing Address - Phone:303-485-1585
Mailing Address - Fax:303-485-1586
Practice Address - Street 1:1260 S HOVER ST
Practice Address - Street 2:STE. E
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7911
Practice Address - Country:US
Practice Address - Phone:303-485-1585
Practice Address - Fax:303-485-1586
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COCO1621152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision