Provider Demographics
NPI:1346325248
Name:WOLFE, DANIEL R (OD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:WOLFE
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 1:2501 WOODHILL DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-3371
Mailing Address - Country:US
Mailing Address - Phone:319-329-9571
Mailing Address - Fax:
Practice Address - Street 1:2600 EDGEWOOD RD SW
Practice Address - Street 2:SUITE 376
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-7818
Practice Address - Country:US
Practice Address - Phone:319-390-4144
Practice Address - Fax:319-390-4674
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10220OtherBCBS
IAV07181Medicare UPIN
IAI16399Medicare ID - Type Unspecified