Provider Demographics
NPI:1033260997
Name:CREEDEN, PAUL T (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:CREEDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 HOME PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4822
Mailing Address - Country:US
Mailing Address - Phone:319-236-0815
Mailing Address - Fax:
Practice Address - Street 1:516 DIVISION ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2382
Practice Address - Country:US
Practice Address - Phone:319-266-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410027324OtherMEDICARE ID
IA0117267Medicaid
IA18418OtherBLUE CROSS BLUE SHIELD
IACG4244OtherMEDICARE ID
IA18418OtherBLUE CROSS BLUE SHIELD
IA0117267Medicaid
IAT88477Medicare UPIN
IA0358460001Medicare NSC