1619948528 NPI number — DR. DELMAR E SPRONK O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619948528 NPI number — DR. DELMAR E SPRONK O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SPRONK

Provider First Name:

DELMAR

Provider Middle Name:

E

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

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:

1619948528

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/13/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

928 3RD AVE

Provider Second Line Business Mailing Address:

PO BOX 100

Provider Business Mailing Address City Name:

SHELDON

Provider Business Mailing Address State Name:

IA

Provider Business Mailing Address Postal Code:

51201-0100

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

712-324-2552

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

928 3RD AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SHELDON

Provider Business Practice Location Address State Name:

IA

Provider Business Practice Location Address Postal Code:

51201-0100

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

712-324-2552

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

01/30/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  1630 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0280578 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1158659 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 23060 . This is a "MEDICARE DME INDIV ID-PAU" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: CE1831 . This is a "RR MEDICARE GROUP PAULLIN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: I7585 . This is a "MEDICARE GROUP PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: I7584 . This is a "MEDICARE GROUP ID-SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 33330 . This is a "WELLMARK GROUP ID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 0158659 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0280586 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 15865 . This is a "MEDICARE DME INDV ID-SHEL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 23060 . This is a "MEDICARE INDIVIDUAL PAULL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 33340 . This is a "WELLMARK GROUP ID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: CS7580 . This is a "RR MEDICARE GROUP SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".