Provider Demographics
NPI:1548263171
Name:DAWSON, THOMAS W (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:DAWSON
Suffix:
Gender:M
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:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-0730
Mailing Address - Country:US
Mailing Address - Phone:352-795-3317
Mailing Address - Fax:352-795-3011
Practice Address - Street 1:1124 NORTH SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5474
Practice Address - Country:US
Practice Address - Phone:352-795-3317
Practice Address - Fax:352-795-3011
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC977152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084385700Medicaid
FLT83984Medicare UPIN
FL084385700Medicaid
FL19271Medicare PIN