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General NPI Number Information
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NPI Number | 1427292366
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Entity Type | Organization
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Legal Business Name | DR OSCAR CORREDOR & ASSOCIATES
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 2409 SE DELAWARE AVE STE 104
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City | ANKENY
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State | IA
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Zip | 50021-4470
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Country | US
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Telephone | 515-963-4404
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Fax | 515-963-4406
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Provider Business Mailing Address
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Address Line | 2409 SE DELAWARE AVE STE 104
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City | ANKENY
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State | IA
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Zip | 50021-4470
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Country | US
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Telephone | 515-963-4404
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Fax | 515-963-4406
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. OSCAR H CORREDOR
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Credential | OD
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Telephone | 515-963-4404
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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 | 2003027013
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002444
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License Number State | IA
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