MEDICARE: DR. JACOB WALTER MULLER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	078249	IA

General Provider Information

NPI Number	:	1154701118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB WALTER MULLER O.D.

Provider Business Mailing Address
First Line	:	505 W SHERIDAN AVE
Second Line	:
City	:	SHENANDOAH
State	:	IA
Zip	:	51601-1705
Country	:	US
Telephone Number	:	712-246-1786
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W SHERIDAN AVE
Second Line	:
City	:	SHENANDOAH
State	:	IA
Zip	:	51601-1705
Country	:	US
Telephone Number	:	712-246-1786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/18/2015

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