1346325248 NPI number — MR. DANIEL R WOLFE O.D.

Table of content: MR. DANIEL R WOLFE O.D. (NPI 1346325248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346325248 NPI number — MR. DANIEL R WOLFE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
DANIEL
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346325248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 WOODHILL DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52404-3371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-329-9571
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 EDGEWOOD RD SW
Provider Second Line Business Practice Location Address:
SUITE 376
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52404-7818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-390-4144
Provider Business Practice Location Address Fax Number:
319-390-4674
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  02334 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10220 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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