1124015912 NPI number — JAMIE W OSTRANDER O.D.

Table of content: JAMIE W OSTRANDER O.D. (NPI 1124015912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124015912 NPI number — JAMIE W OSTRANDER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSTRANDER
Provider First Name:
JAMIE
Provider Middle Name:
W
Provider Name Prefix Text:
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:
1124015912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 DUFF AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-239-4400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 HEIRES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51401-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-792-3318
Provider Business Practice Location Address Fax Number:
712-792-3319
Provider Enumeration Date:
10/05/2005

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:  02131 , 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: 05321 . This is a "WELLMARK JEFFERSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2184234 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18774 . This is a "WELLMARK IDA GROVE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 72860 . This is a "COVENTRY JEFFERSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0184234 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228841 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 73807 . This is a "COVENTRY CARROLL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 052237 . This is a "HEALTH ALLIANCE CARROLL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 056848 . This is a "HEALTH ALLIANCE JEFFERSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1184234 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48241 . This is a "WELLMARK CARROLL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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