Healthcare Provider Details

I. General information

NPI: 1003803677
Provider Name (Legal Business Name): LISA ANNE DAWSON-CLAUSEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANNE DAWSON O.D.

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 DULUTH AVE SE STE 100
PRIOR LAKE MN
55372-2883
US

IV. Provider business mailing address

16250 DULUTH AVE SE STE 100
PRIOR LAKE MN
55372-2883
US

V. Phone/Fax

Practice location:
  • Phone: 952-447-2020
  • Fax: 952-447-2322
Mailing address:
  • Phone: 952-447-2020
  • Fax: 952-447-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2731
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: