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NPI Code Detail

MEDICARE: LISA ANNE DAWSON-CLAUSEN O.D.

MEDICARE:   LISA ANNE DAWSON-CLAUSEN  O.D.
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
1152W00000XOptometrist2731MN

General Provider Information

NPI Number : 1003803677
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANNE DAWSON-CLAUSEN O.D.
Provider Business Mailing Address
First Line : 16250 DULUTH AVE SE STE 100
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-2883
Country : US
Telephone Number : 952-447-2020
Fax Number : 952-447-2322
Provider Business Practice Location Address
First Line : 16250 DULUTH AVE SE STE 100
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-2883
Country : US
Telephone Number : 952-447-2020
Fax Number : 952-447-2322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 03/12/2020

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