Provider Demographics
NPI:1518951433
Name:BIRCHANSKY, LEE DARON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:DARON
Last Name:BIRCHANSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 H AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4624
Mailing Address - Country:US
Mailing Address - Phone:319-362-9855
Mailing Address - Fax:319-362-0655
Practice Address - Street 1:1136 H AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4624
Practice Address - Country:US
Practice Address - Phone:319-362-9855
Practice Address - Fax:319-362-0655
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26858207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180006441OtherRAILROAD MEDICARE
5340733OtherAETNA
42137560201OtherHERITAGE
07593OtherWELLMARK BCBS
IA2265686Medicaid
IA2265686Medicaid
07593OtherWELLMARK BCBS