MEDICARE: MR. DANIEL R WOLFE 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	02334	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10220	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1346325248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL R WOLFE O.D.

Provider Business Mailing Address
First Line	:	2501 WOODHILL DR SW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-3371
Country	:	US
Telephone Number	:	319-329-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 EDGEWOOD RD SW
Second Line	:	SUITE 376
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-7818
Country	:	US
Telephone Number	:	319-390-4144
Fax Number	:	319-390-4674

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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