Provider Demographics
NPI:1982765343
Name:MACCREERY, DAWN Y (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:Y
Last Name:MACCREERY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1705 WHITEGATE LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2278
Mailing Address - Country:US
Mailing Address - Phone:517-323-8060
Mailing Address - Fax:
Practice Address - Street 1:5660 W SAGINAW HWY
Practice Address - Street 2:SPACE 113 LANSING MALL
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2455
Practice Address - Country:US
Practice Address - Phone:517-321-5545
Practice Address - Fax:517-321-8344
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040088Medicare PIN
MIT91315Medicare UPIN