Healthcare Provider Details

I. General information

NPI: 1659439958
Provider Name (Legal Business Name): DAWN L. BOHNERT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN LOUISE BOHNERT OD

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 PERRY ST
LA PORTE IN
46350-3200
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 219-325-0404
  • Fax: 219-325-0335
Mailing address:
  • Phone: 703-847-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002867A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: