Healthcare Provider Details

I. General information

NPI: 1083693337
Provider Name (Legal Business Name): JUSTIN M SCHULTE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WESTOWN PKWY
WEST DES MOINES IA
50266-7705
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 515-327-6100
  • Fax: 515-223-5468
Mailing address:
  • Phone: 641-754-6262
  • Fax: 641-752-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02267
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: