MEDICARE: DR. DAWN WATTENHOFER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0553	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0006985	OTHER	SD	BCBS OF SD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154390573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN WATTENHOFER O.D.

Provider Business Mailing Address
First Line	:	318 MOUNT RUSHMORE RD STE A
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2762
Country	:	US
Telephone Number	:	605-399-3937
Fax Number	:	605-399-5910

Provider Business Practice Location Address
First Line	:	318 MOUNT RUSHMORE RD STE A
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2762
Country	:	US
Telephone Number	:	605-399-3937
Fax Number	:	605-399-5910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/12/2015

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