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NPI Code Detail

MEDICARE: DOUGLAS C SPYRISON O.D.

MEDICARE: DOUGLAS C SPYRISON 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
1152W00000XOptometrist1760IA
2152WL0500XLow Vision Rehabilitation Optometrist1760IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871580498
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS C SPYRISON O.D.
Provider Business Mailing Address
First Line : 1705 DELHI ST
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-5934
Country : US
Telephone Number : 563-588-4651
Fax Number : 563-557-1073
Provider Business Practice Location Address
First Line : 1705 DELHI ST
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-5934
Country : US
Telephone Number : 563-588-4651
Fax Number : 563-557-1073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 06/02/2008

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