MEDICARE: DR. CORD ROBERT LINVILLE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	354635	WI
2	152W00000X	Optometrist	2018021080	MO

General Provider Information

NPI Number	:	1184119018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORD ROBERT LINVILLE OD

Provider Business Mailing Address
First Line	:	6004 SW 9TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50315-5011
Country	:	US
Telephone Number	:	515-287-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	6004 SW 9TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50315-5011
Country	:	US
Telephone Number	:	515-287-0820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2018
Last Update Date	:	09/29/2021

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Directions to “ DR. CORD ROBERT LINVILLE OD” Practice Location

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