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General NPI Number Information
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NPI Number | 1467449686
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Entity Type | Organization
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Legal Business Name | DR. J. BRENT ALTFILLISCH, O.D. P.C.
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 224 E MAIN ST
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City | OTTUMWA
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State | IA
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Zip | 52501-2916
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Country | US
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Telephone | 641-684-5463
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Fax | 641-684-5475
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Provider Business Mailing Address
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Address Line | 224 E MAIN ST PO BOX 994
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City | OTTUMWA
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State | IA
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Zip | 52501-2916
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Country | US
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Telephone | 641-684-5463
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Fax | 641-684-5475
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOHN BRENT ALTFILLISCH
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Credential | O.D.
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Telephone | 641-684-5463
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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 | 1537
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License Number State | IA
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