Provider Demographics
NPI:1881783868
Name:DAWSON, MARIETTA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIETTA
Middle Name:
Last Name:DAWSON
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 1:6007 44TH AVE.
Mailing Address - Street 2:#3
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1569
Mailing Address - Country:US
Mailing Address - Phone:706-761-8920
Mailing Address - Fax:
Practice Address - Street 1:1825 K STREET NW
Practice Address - Street 2:1103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:240-737-5160
Practice Address - Fax:240-737-5101
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA2136152W00000X
DCOP100188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist