Provider Demographics
NPI:1588612733
Name:FESER, ROBERT J (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:FESER
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:PO BOX 278
Mailing Address - Street 2:208 WEST BLUFF STREET
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-0278
Mailing Address - Country:US
Mailing Address - Phone:712-225-6151
Mailing Address - Fax:712-225-2276
Practice Address - Street 1:208 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1817
Practice Address - Country:US
Practice Address - Phone:712-225-6151
Practice Address - Fax:712-225-2276
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0004119Medicaid
IA0004119Medicaid
IA17847Medicare ID - Type Unspecified