Healthcare Provider Details

I. General information

NPI: 1285618496
Provider Name (Legal Business Name): CEDAR VALLEY OPHTHALMOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 CYCLONE DR
WATERLOO IA
50701-9746
US

IV. Provider business mailing address

2515 CYCLONE DR
WATERLOO IA
50701-9746
US

V. Phone/Fax

Practice location:
  • Phone: 319-433-3000
  • Fax: 319-232-1155
Mailing address:
  • Phone: 319-433-3000
  • Fax: 319-232-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02050
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number24873
License Number StateIA

VIII. Authorized Official

Name: RICHARD C MAUER
Title or Position: PRESIDENT
Credential: MD
Phone: 319-433-3000