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General NPI Number Information
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NPI Number | 1679544696
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Entity Type | Individual
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Provider Name | RACHEL V MORTENSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 208 8TH AVE SE
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City | OELWEIN
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State | IA
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Zip | 50662-2448
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Country | US
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Telephone | 319-283-3628
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Fax | 319-283-5638
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Provider Business Mailing Address
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Address Line | 208 8TH AVE SE
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City | OELWEIN
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State | IA
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Zip | 50662-2448
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Country | US
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Telephone | 319-283-3628
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Fax | 319-283-5638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2165
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License Number State | IA
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