MEDICARE: DR. DAWN M BIRCH 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	046.007794	IL
2	152W00000X	Optometrist	46-007794	IL

General Provider Information

NPI Number	:	1356404248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN M BIRCH O.D.

Provider Business Mailing Address
First Line	:	1720 S MICHIGAN AVE
Second Line	:	3302
City	:	CHICAGO
State	:	IL
Zip	:	60616-1465
Country	:	US
Telephone Number	:	773-343-7638
Fax Number	:	312-641-5503

Provider Business Practice Location Address
First Line	:	6254 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4610
Country	:	US
Telephone Number	:	773-581-1515
Fax Number	:	773-581-9663

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/11/2021

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