Provider Demographics
NPI:1437203031
Name:TAYLOR, DENNIS R (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:TAYLOR
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 1:1122 18TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2725
Mailing Address - Country:US
Mailing Address - Phone:712-262-4785
Mailing Address - Fax:
Practice Address - Street 1:714 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5730
Practice Address - Country:US
Practice Address - Phone:712-262-3982
Practice Address - Fax:712-262-7831
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0162826Medicaid
IA16282OtherBCBS
410008780OtherRR MCR
410008780OtherRR MCR
IA0162826Medicaid