MEDICARE: TARRA VANDER LEEST OD PC

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	02288	IA

General Provider Information

NPI Number	:	1194806117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRA VANDER LEEST OD PC

Provider Business Mailing Address
First Line	:	3135 SUNNER AVE
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-7678
Country	:	US
Telephone Number	:	712-330-0276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 18TH ST
Second Line	:	SUITE E
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1163
Country	:	US
Telephone Number	:	712-336-4401
Fax Number	:	712-336-4403

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TARRA L VANDER LEEST
Credential	:	O.D.
Telephone Number	:	712-330-0276

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	12/23/2023

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