Physician Compare National (NPI:1689684466)

HEALTHCARE PROVIDER: DAWN T VAN OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1689684466
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355360967
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20051114000272
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VAN
	Individual professional last name
Provider First Name	DAWN
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	NOVA SOUTHEASTERN UNIV COLLEGE OF DENTAL MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	151 SW 184TH AVE
	Group Practice or individual's line 1 address
City	PEMBROKE PINES
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	330295465
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y