Healthcare Provider Details

I. General information

NPI: 1043284805
Provider Name (Legal Business Name): PAUL WESLEY HOTTEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 WILLIAM STREET
IOWA CITY IA
52240-6625
US

IV. Provider business mailing address

1060 WILLIAM ST
IOWA CITY IA
52240-6625
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-9275
  • Fax: 319-338-2499
Mailing address:
  • Phone: 319-338-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1775
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: