Provider Demographics
NPI:1659350148
Name:FICK, ORLIN JAMES (OD)
Entity Type:Individual
Prefix:
First Name:ORLIN
Middle Name:JAMES
Last Name:FICK
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 1:54 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2601
Mailing Address - Country:US
Mailing Address - Phone:712-246-4526
Mailing Address - Fax:
Practice Address - Street 1:505 W SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1705
Practice Address - Country:US
Practice Address - Phone:712-246-1786
Practice Address - Fax:712-246-1182
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07372OtherBCBS
NE100249544-00Medicaid
1659350148OtherBLOCK VISION
IA2218776Medicaid
22-001144OtherUHC
24361OtherMIDLANDS CHOICE
930597OtherEYEMED
1659350148OtherBLOCK VISION
IA1309730001Medicare NSC
930597OtherEYEMED
IA07372Medicare PIN