Provider Demographics
NPI:1215106117
Name:DR. K. DAWN LUVAAS
Entity type:Organization
Organization Name:DR. K. DAWN LUVAAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LUVAAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-834-2165
Mailing Address - Street 1:123 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1102
Mailing Address - Country:US
Mailing Address - Phone:814-834-2165
Mailing Address - Fax:814-834-9450
Practice Address - Street 1:123 CENTER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1102
Practice Address - Country:US
Practice Address - Phone:814-834-2165
Practice Address - Fax:814-834-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000619332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0653430001Medicare NSC