MEDICARE: TERRY D. HUSEMAN OD PC

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	IA02224	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1407838436	OTHER		INDIVIDUAL NPI NUMBER
2	1932189354	OTHER	IA	INDIVIDUAL NPI NUMBER
3	1043280977	OTHER	IA	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1548328867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY D. HUSEMAN OD PC

Provider Business Mailing Address
First Line	:	1551 VALLEY WEST DR
Second Line	:	SUITE 242
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1112
Country	:	US
Telephone Number	:	515-224-9681
Fax Number	:	515-224-9687

Provider Business Practice Location Address
First Line	:	1551 VALLEY WEST DR
Second Line	:	SUITE 242
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1112
Country	:	US
Telephone Number	:	515-224-9681
Fax Number	:	515-224-9687

Authorized Official
Title or Position	:	INSURANCE PROCESSOR
Name	:	MRS. BRIGITTE POWERS
Credential	:
Telephone Number	:	515-224-9681

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	11/19/2007

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