Healthcare Provider Details

I. General information

NPI: 1174463889
Provider Name (Legal Business Name): VICTORIA LEIGH CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 6TH ST STE 101
NEVADA IA
50201-1872
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5400
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-4626
  • Fax:
Mailing address:
  • Phone: 515-239-4418
  • Fax: 515-956-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number139491
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: