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General NPI Number Information
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NPI Number | 1225015597
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Entity Type | Organization
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Legal Business Name | OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 300 N GRANDVIEW AVE
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City | DUBUQUE
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State | IA
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Zip | 52001-6397
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Country | US
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Telephone | 563-588-4675
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Fax | 563-588-1195
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Provider Business Mailing Address
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Address Line | 300 N GRANDVIEW AVE
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City | DUBUQUE
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State | IA
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Zip | 52001-6397
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Country | US
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Telephone | 563-588-4675
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Fax | 563-588-1195
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | MR. BRYAN PAUL PECHOUS
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Credential | MD
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Telephone | 563-588-4675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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