Provider Demographics
NPI:1427029388
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:712-448-2195
Mailing Address - Street 1:116 E BROADWAY
Mailing Address - Street 2:PO BOX 450
Mailing Address - City:PAULLINA
Mailing Address - State:IA
Mailing Address - Zip Code:51046-0450
Mailing Address - Country:US
Mailing Address - Phone:712-448-2195
Mailing Address - Fax:712-448-2196
Practice Address - Street 1:116 E BROADWAY
Practice Address - Street 2:
Practice Address - City:PAULLINA
Practice Address - State:IA
Practice Address - Zip Code:51046-0450
Practice Address - Country:US
Practice Address - Phone:712-448-2195
Practice Address - Fax:712-448-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33340OtherWELLMARK GROUP ID
IA0280578Medicaid
IACE1831OtherRR MEDICARE GROUP
IACE1831OtherRR MEDICARE GROUP
IA0280578Medicaid