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NPI Code Detail

MEDICARE: MYRA N MENDOZA O.D

MEDICARE: MYRA N MENDOZA O.D
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
1152W00000XOptometristOPT12839IA
2152W00000XOptometrist02361IA

General Provider Information

NPI Number : 1235126376
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRA N MENDOZA O.D
Provider Business Mailing Address
First Line : 309 E CHURCH ST
Second Line :
City : MARSHALLTOWN
State : IA
Zip : 50158-2946
Country : US
Telephone Number : 641-754-6262
Fax Number : 641-754-7420
Provider Business Practice Location Address
First Line : 2020 PHILADELPHIA ST
Second Line :
City : AMES
State : IA
Zip : 50010-8772
Country : US
Telephone Number : 515-663-4800
Fax Number : 515-232-3532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 05/12/2015

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