Dawson, Audrey Simone
Dawson, Audrey Simone is an individual health care provider with primary practice located at 6050 Sterling Creek Rd , Portage IN 46368-7752. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Dawson, Audrey Simone can be contacted via phone (219) 763-8112.Contact Information
Primary practice address
6050 Sterling Creek Rd
Portage IN 46368-7752
Phone: (219) 763-8112
Fax: (219) 764-5380
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18004139A | Indiana |
Profile Details
| NPI number | 1053889915 |
|---|---|
| LBN Legal business name | Dawson, Audrey Simone |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 8th, 2018 |
| Last updated | Aug 17th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053889915 | NPPES |
| Indiana | Other | 191360037 | MEDICARE PTAN |
| Indiana | MEDICAID | 300021049 | MEDICARE PTAN |
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