Provider Demographics
NPI:1497776983
Name:URBAITIS, JOSEPH CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:URBAITIS
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 1:3625 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1646
Mailing Address - Country:US
Mailing Address - Phone:563-355-4716
Mailing Address - Fax:563-355-5034
Practice Address - Street 1:3625 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1646
Practice Address - Country:US
Practice Address - Phone:563-355-4716
Practice Address - Fax:563-355-5034
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAUR702901OtherCLARITY
IA1089482Medicaid
IA2864030001OtherDMERC
IA1089482Medicaid
IA2864030001OtherDMERC