Provider Demographics
NPI:1619943214
Name:IHRKE, SCOTT BRADLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRADLEY
Last Name:IHRKE
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 1:120 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3508
Mailing Address - Country:US
Mailing Address - Phone:712-546-4183
Mailing Address - Fax:712-548-4101
Practice Address - Street 1:120 1ST ST NW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3508
Practice Address - Country:US
Practice Address - Phone:712-546-4183
Practice Address - Fax:712-548-4101
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0132811Medicaid
CC8412OtherRR MEDICARE
52788OtherBCBS
I9436Medicare PIN
52788OtherBCBS
IA0132811Medicaid