Healthcare Provider Details

I. General information

NPI: 1891089546
Provider Name (Legal Business Name): AUDREY KO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SE TALLGRASS LN STE 210
WAUKEE IA
50263-6817
US

IV. Provider business mailing address

7147 VISTA DR STE 150
WEST DES MOINES IA
50266-9317
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9480
  • Fax: 515-875-9481
Mailing address:
  • Phone: 515-875-9255
  • Fax: 515-875-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD-44227
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-44227
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: