MEDICARE: THOMAS W DAWSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	OPC977	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003082561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS W DAWSON OD

Provider Business Mailing Address
First Line	:	PO BOX 730
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34423-0730
Country	:	US
Telephone Number	:	352-795-3317
Fax Number	:	352-795-3317

Provider Business Practice Location Address
First Line	:	1124 N SUNCOAST BLVD
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-5474
Country	:	US
Telephone Number	:	352-795-3317
Fax Number	:	352-795-3011

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	MRS. MARY F DAWSON
Credential	:
Telephone Number	:	352-795-3317

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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