MEDICARE: MCDONALD OPTICAL DISPENSARY INC

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		IA

General Provider Information

NPI Number	:	1689655961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCDONALD OPTICAL DISPENSARY INC

Provider Business Mailing Address
First Line	:	1301 S GILBERT ST STE C2
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4559
Country	:	US
Telephone Number	:	319-337-3737
Fax Number	:	319-359-4000

Provider Business Practice Location Address
First Line	:	1301 S GILBERT ST STE C2
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4559
Country	:	US
Telephone Number	:	319-337-3737
Fax Number	:	319-359-4000

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	TERESA LYNN HASBROUCK
Credential	:
Telephone Number	:	319-337-3737

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	10/18/2022

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