Provider Demographics
NPI:1558547141
Name:LEMARS OPTOMETRIC CENTER PC
Entity Type:Organization
Organization Name:LEMARS OPTOMETRIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-546-6803
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-0436
Mailing Address - Country:US
Mailing Address - Phone:712-546-6803
Mailing Address - Fax:712-548-4151
Practice Address - Street 1:38 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3515
Practice Address - Country:US
Practice Address - Phone:712-546-6803
Practice Address - Fax:712-548-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0145946Medicaid
IA14594Medicare PIN
IAT00884Medicare UPIN
IA0145946Medicaid