Healthcare Provider Details

I. General information

NPI: 1689507311
Provider Name (Legal Business Name): DAWSON THOMAS WINTERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 LAKE AVE
FORT WAYNE IN
46805-5100
US

IV. Provider business mailing address

2018 BAYER AVE
FORT WAYNE IN
46805-3415
US

V. Phone/Fax

Practice location:
  • Phone: 126-042-6543
  • Fax:
Mailing address:
  • Phone: 260-615-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004668A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: