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General NPI Number Information
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NPI Number | 1447474630
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Entity Type | Organization
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Legal Business Name | DAVID S SYBESMA, OD, PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 1408 43RD STREET
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City | MAQUOKETA
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State | IA
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Zip | 52060-3056
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Country | US
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Telephone | 563-652-2795
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Fax | 563-652-5210
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Provider Business Mailing Address
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Address Line | 1408 43RD STREET
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City | MAQUOKETA
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State | IA
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Zip | 52060-3056
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Country | US
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Telephone | 563-652-2795
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Fax | 563-652-5210
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID SCOTT SYBESMA
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Credential | O.D.
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Telephone | 563-652-2795
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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 | 1996
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License Number State | IA
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