Provider Demographics
NPI:1902835713
Name:DAWSON, MONIQUE L (OD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:L
Last Name:DAWSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6661
Mailing Address - Country:US
Mailing Address - Phone:203-238-4150
Mailing Address - Fax:203-238-4437
Practice Address - Street 1:533 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6661
Practice Address - Country:US
Practice Address - Phone:203-238-4150
Practice Address - Fax:203-238-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist