Provider Demographics
NPI:1467606020
Name:MICHAEL JAMES RINGBLUM OD PC
Entity Type:Organization
Organization Name:MICHAEL JAMES RINGBLUM OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RINGBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-332-7478
Mailing Address - Street 1:3378 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3403
Mailing Address - Country:US
Mailing Address - Phone:563-332-7478
Mailing Address - Fax:563-332-7304
Practice Address - Street 1:3378 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3403
Practice Address - Country:US
Practice Address - Phone:563-332-7478
Practice Address - Fax:563-332-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA243733Medicare UPIN