Provider Demographics
NPI:1376661777
Name:DUBUQUE OPTOMETRIC, P.C.
Entity Type:Organization
Organization Name:DUBUQUE OPTOMETRIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LESTER-HOWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-588-2093
Mailing Address - Street 1:3343 CENTER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-5264
Mailing Address - Country:US
Mailing Address - Phone:563-588-2093
Mailing Address - Fax:563-588-0590
Practice Address - Street 1:3343 CENTER GROVE DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-5264
Practice Address - Country:US
Practice Address - Phone:563-588-2093
Practice Address - Fax:563-588-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07574OtherWELLMARK BLUE CROSS BLUE
IA0084616Medicaid
IA07574Medicare UPIN
IA0413960001Medicare NSC