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General NPI Number Information
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NPI Number | 1285618496
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Entity Type | Organization
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Legal Business Name | CEDAR VALLEY OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 2515 CYCLONE DR
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City | WATERLOO
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State | IA
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Zip | 50701-9746
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Country | US
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Telephone | 319-433-3000
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Fax | 319-232-1155
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Provider Business Mailing Address
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Address Line | 2515 CYCLONE DR
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City | WATERLOO
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State | IA
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Zip | 50701-9746
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Country | US
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Telephone | 319-433-3000
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Fax | 319-232-1155
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD C MAUER
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Credential | MD
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Telephone | 319-433-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02050
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 24873
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License Number State | IA
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