MEDICARE: THOMAS W DAWSON OD

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	152WC0802X	Corneal and Contact Management Optometrist	OPC977	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548263171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS W DAWSON OD

Provider Business Mailing Address
First Line	:	PO BOX 730
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34423-0730
Country	:	US
Telephone Number	:	352-795-3317
Fax Number	:	352-795-3011

Provider Business Practice Location Address
First Line	:	1124 NORTH SUNCOAST BLVD
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-5474
Country	:	US
Telephone Number	:	352-795-3317
Fax Number	:	352-795-3011

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/28/2010

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