Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2731 | MN |
NPI | 1003803677 |
---|---|
Provider Name | Lisa Anne Dawson-Clausen |
First Address | Prior Lake, MN 55372-2883 |
Second Address | Prior Lake, MN 55372-2883 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 12/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U84698 | (02) |