Healthcare Provider Details

I. General information

NPI: 1346528858
Provider Name (Legal Business Name): SAMANTHA VAASSEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

IV. Provider business mailing address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-4115
  • Fax: 563-584-4256
Mailing address:
  • Phone: 563-584-4115
  • Fax: 563-584-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002564
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: