MEDICARE: DAWN BEARDEN 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
1	152W00000X	Optometrist	2885	FL

General Provider Information

NPI Number	:	1851607758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN BEARDEN O.D.

Provider Business Mailing Address
First Line	:	209 N FORT LAUDERDALE BEACH BLVD
Second Line	:	11G
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-4365
Country	:	US
Telephone Number	:	954-303-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1567 S FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2686
Country	:	US
Telephone Number	:	954-763-2842
Fax Number	:	954-763-2850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	10/01/2016

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