Provider Demographics
NPI:1104961457
Name:MOCZEK, DAWN M (OD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MOCZEK
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 1:7675 VOICE OF AMERICA CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2795
Mailing Address - Country:US
Mailing Address - Phone:513-313-7731
Mailing Address - Fax:
Practice Address - Street 1:7675 VOICE OF AMERICA CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-777-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1881739142OtherD.M. MOCZEK OPTOMETRIST LLC