1659350148 NPI number — ORLIN JAMES FICK O.D.

Table of content: KELLY KENNEDY CNP (NPI 1730783754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659350148 NPI number — ORLIN JAMES FICK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FICK
Provider First Name:
ORLIN
Provider Middle Name:
JAMES
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:
1659350148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 KEITH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51601-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-246-4526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 W SHERIDAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51601-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-246-1786
Provider Business Practice Location Address Fax Number:
712-246-1182
Provider Enumeration Date:
01/12/2006

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:  01817 , 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: 07372 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 100249544-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659350148 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2218776 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-001144 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24361 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 930597 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".




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