Provider Demographics
NPI:1588736805
Name:JEREMY L DANSON OD PA
Entity type:Organization
Organization Name:JEREMY L DANSON OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-756-2131
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-0426
Mailing Address - Country:US
Mailing Address - Phone:512-756-2131
Mailing Address - Fax:512-756-7831
Practice Address - Street 1:2801 S WATER ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4515
Practice Address - Country:US
Practice Address - Phone:512-756-2131
Practice Address - Fax:512-756-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05773TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192237901Medicaid
TXDF8155OtherPALMETTO GBA RAILROAD MED
TX00X727Medicare PIN
TXDF8155OtherPALMETTO GBA RAILROAD MED
TXU75775Medicare UPIN