MEDICARE: DUBUQUE OPTOMETRIC, P.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07574	OTHER	IA	WELLMARK BLUE CROSS BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376661777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUBUQUE OPTOMETRIC, P.C.

Provider Business Mailing Address
First Line	:	3343 CENTER GROVE DR
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52003-5264
Country	:	US
Telephone Number	:	563-588-2093
Fax Number	:	563-588-0590

Provider Business Practice Location Address
First Line	:	3343 CENTER GROVE DR
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52003-5264
Country	:	US
Telephone Number	:	563-588-2093
Fax Number	:	563-588-0590

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	LYNN M LESTER-HOWLAND
Credential	:
Telephone Number	:	563-588-2093

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	05/02/2013

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Directions to “DUBUQUE OPTOMETRIC, P.C. ” Practice Location

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