Healthcare Provider Details

I. General information

NPI: 1215925227
Provider Name (Legal Business Name): BRANDON GLEN STALZER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 NORTHGATE DR
IOWA CITY IA
52245-9565
US

IV. Provider business mailing address

2629 NORTHGATE DR
IOWA CITY IA
52245-9565
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-3623
  • Fax:
Mailing address:
  • Phone: 319-338-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02290
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: