Provider Demographics
NPI:1124241377
Name:STERLING BRYANT DAWSON
Entity type:Organization
Organization Name:STERLING BRYANT DAWSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:580-436-0243
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-0607
Mailing Address - Country:US
Mailing Address - Phone:580-436-0243
Mailing Address - Fax:580-436-0243
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5604
Practice Address - Country:US
Practice Address - Phone:580-436-0243
Practice Address - Fax:580-436-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100812580AMedicaid