Provider Demographics
NPI:1144212358
Name:VANNATTA, DENNIS ROY (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROY
Last Name:VANNATTA
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 1:4600 SINGING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9702
Mailing Address - Country:US
Mailing Address - Phone:712-271-4600
Mailing Address - Fax:712-271-4604
Practice Address - Street 1:4600 SINGING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9702
Practice Address - Country:US
Practice Address - Phone:712-271-4600
Practice Address - Fax:712-271-4604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3214791Medicaid
IA2214791Medicaid
IA42349Medicare ID - Type Unspecified
IA3214791Medicaid
IA2214791Medicaid