Provider Demographics
NPI:1063515864
Name:DAWSON, MICHELLE ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
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 1:57 METRIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2338
Mailing Address - Country:US
Mailing Address - Phone:330-630-2580
Mailing Address - Fax:234-542-1332
Practice Address - Street 1:57 METRIC DRIVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2338
Practice Address - Country:US
Practice Address - Phone:330-630-2580
Practice Address - Fax:234-542-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2885856Medicaid
OHDA4219682Medicare PIN