=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588668263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEGGY SUE DRIESEN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 N MAIN AVE
-----------------------------------------------------
City | SIOUX CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51250-1852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-722-2051
-----------------------------------------------------
Fax | 712-722-4531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20
-----------------------------------------------------
City | SIOUX CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51250-0020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-722-2051
-----------------------------------------------------
Fax | 712-722-4531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2032
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------