Provider Demographics
NPI:1073800363
Name:DANIEL R WOLFE OD PC
Entity Type:Organization
Organization Name:DANIEL R WOLFE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-329-9571
Mailing Address - Street 1:2501 WOODHILL DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404
Mailing Address - Country:US
Mailing Address - Phone:319-329-9571
Mailing Address - Fax:319-338-2165
Practice Address - Street 1:2501 WOODHILL DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3371
Practice Address - Country:US
Practice Address - Phone:319-329-9571
Practice Address - Fax:319-338-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty