Provider Demographics
NPI:1043315633
Name:R.D. ESPE OD, PC
Entity Type:Organization
Organization Name:R.D. ESPE OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DORAN
Authorized Official - Last Name:ESPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-334-6087
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-0737
Mailing Address - Country:US
Mailing Address - Phone:319-334-6087
Mailing Address - Fax:319-334-6488
Practice Address - Street 1:1310 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2316
Practice Address - Country:US
Practice Address - Phone:319-334-6087
Practice Address - Fax:319-334-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1665T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18148Medicare PIN
IA0171580001Medicare NSC