Healthcare Provider Details

I. General information

NPI: 1669788956
Provider Name (Legal Business Name): MCDONALD OPTICAL DISPENSARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S CLINTON ST BOX 1940
IOWA CITY IA
52240-3912
US

IV. Provider business mailing address

16 S CLINTON ST
IOWA CITY IA
52240-3912
US

V. Phone/Fax

Practice location:
  • Phone: 319-337-4995
  • Fax: 319-358-5707
Mailing address:
  • Phone: 319-337-4995
  • Fax: 319-358-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: REID A MCDONALD
Title or Position: OWNER
Credential:
Phone: 319-337-4995