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General NPI Number Information
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NPI Number | 1568649275
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Entity Type | Organization
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Legal Business Name | DAWN T VAN O D P A
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 151 SW 184TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-5465
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Country | US
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Telephone | 954-437-8777
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Fax | 954-442-6524
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Provider Business Mailing Address
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Address Line | 151 SW 184TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-5465
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Country | US
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Telephone | 954-437-8777
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Fax | 954-442-6524
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Authorized Official
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Title or Position | OPTOMETRIST SOLE PROPRIETOR
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Name | DR. DAWN T VAN
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Credential | O D
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Telephone | 954-437-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3746
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License Number State | FL
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