Healthcare Provider Details

I. General information

NPI: 1427037787
Provider Name (Legal Business Name): DEAN ALBIN VER MULM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 BROADWAY
EMMETSBURG IA
50536
US

IV. Provider business mailing address

PO BOX 416 804 BROADWAY
EMMETSBURG IA
50536-0416
US

V. Phone/Fax

Practice location:
  • Phone: 712-852-4123
  • Fax: 712-852-4864
Mailing address:
  • Phone: 712-852-4123
  • Fax: 712-852-4864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02022
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: