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General NPI Number Information
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NPI Number | 1598199218
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Entity Type | Organization
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Legal Business Name | KAILA EGAN O.D., PLLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 918 DECATHLON DR
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City | WATERLOO
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State | IA
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Zip | 50701-3441
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Country | US
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Telephone | 319-236-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 918 DECATHLON DR
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City | WATERLOO
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State | IA
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Zip | 50701-3441
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Country | US
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Telephone | 319-236-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | KAILA EGAN
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Credential | O.D.
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Telephone | 319-236-2020
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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 | 002596
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License Number State | IA
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