Provider Demographics
NPI:1790092914
Name:ROMSDAHL, ERIK MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:MICHAEL
Last Name:ROMSDAHL
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 1:2525 N ANKENY BLVD
Mailing Address - Street 2:STE 109
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4714
Mailing Address - Country:US
Mailing Address - Phone:515-964-7541
Mailing Address - Fax:515-964-7568
Practice Address - Street 1:2525 N ANKENY BLVD
Practice Address - Street 2:STE 109
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4714
Practice Address - Country:US
Practice Address - Phone:515-964-7541
Practice Address - Fax:515-964-7568
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002511152WV0400X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1003187865Medicaid