MEDICARE: THOMAS R MUNGER OD

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	02230	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410048396	OTHER	IA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1578555389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS R MUNGER OD

Provider Business Mailing Address
First Line	:	202 S 6TH ST
Second Line	:	PO BOX 517
City	:	SAC CITY
State	:	IA
Zip	:	50583-2242
Country	:	US
Telephone Number	:	712-662-7777
Fax Number	:	712-662-7311

Provider Business Practice Location Address
First Line	:	202 N 6TH ST
Second Line	:
City	:	SAC CITY
State	:	IA
Zip	:	50583-1742
Country	:	US
Telephone Number	:	712-662-7777
Fax Number	:	712-662-7311

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	05/12/2015

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