=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497747299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUIS J SCALLON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2005
-----------------------------------------------------
Last Update Date | 05/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 PHILADELPHIA ST
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-8772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-232-2450
-----------------------------------------------------
Fax | 515-232-3532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 E CHURCH ST
-----------------------------------------------------
City | MARSHALLTOWN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50158-2946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-754-6200
-----------------------------------------------------
Fax | 641-752-7420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 26457
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------