Provider Demographics
NPI:1346211257
Name:SPRONK VANDER GRIEND & RADKE
Entity Type:Organization
Organization Name:SPRONK VANDER GRIEND & RADKE
Other - Org Name:DRS. SPRONK, VANDER GRIEND & RADKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELMAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPRONK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-324-2552
Mailing Address - Street 1:928 3RD AVE
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-0100
Mailing Address - Country:US
Mailing Address - Phone:712-324-2552
Mailing Address - Fax:712-324-2553
Practice Address - Street 1:928 3RD AVE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-0100
Practice Address - Country:US
Practice Address - Phone:712-324-2552
Practice Address - Fax:712-324-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0280586Medicaid
IA33330OtherGROUP ID
IACS7580OtherRR MEDICARE
IAI7584OtherMEDICARE GROUP ID
IA0280586Medicaid