Provider Demographics
NPI:1689655961
Name:MCDONALD OPTICAL DISPENSARY INC
Entity Type:Organization
Organization Name:MCDONALD OPTICAL DISPENSARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HASBROUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-3737
Mailing Address - Street 1:1301 S GILBERT ST STE C2
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4559
Mailing Address - Country:US
Mailing Address - Phone:319-337-3737
Mailing Address - Fax:319-359-4000
Practice Address - Street 1:1301 S GILBERT ST STE C2
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4559
Practice Address - Country:US
Practice Address - Phone:319-337-3737
Practice Address - Fax:319-359-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02660Medicare PIN
02660Medicare ID - Type Unspecified
IA6708490001Medicare NSC