Provider Demographics
NPI:1427037787
Name:VER MULM, DEAN ALBIN (OD)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:ALBIN
Last Name:VER MULM
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:PO BOX 416
Mailing Address - Street 2:804 BROADWAY
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-0416
Mailing Address - Country:US
Mailing Address - Phone:712-852-4123
Mailing Address - Fax:712-852-4864
Practice Address - Street 1:804 BROADWAY
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536
Practice Address - Country:US
Practice Address - Phone:712-852-4123
Practice Address - Fax:712-852-4864
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0100768Medicaid
IA12606Medicare PIN
IA0606280001Medicare NSC
U43685Medicare UPIN