Healthcare Provider Details

I. General information

NPI: 1295046134
Provider Name (Legal Business Name): DANIELLE J RIES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 OKOBOJI AVENUE
MILFORD IA
51351-1275
US

IV. Provider business mailing address

2213 OKOBOJI AVENUE
MILFORD IA
51351-1275
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-7000
  • Fax: 888-972-4811
Mailing address:
  • Phone: 712-338-7000
  • Fax: 888-972-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002490
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: