Provider Demographics
NPI:1801859228
Name:CHIZEK, AMMIE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMMIE
Middle Name:MARIE
Last Name:CHIZEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMMIE
Other - Middle Name:MARIE
Other - Last Name:MATHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-2005
Mailing Address - Country:US
Mailing Address - Phone:563-285-6855
Mailing Address - Fax:
Practice Address - Street 1:1875 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3203
Practice Address - Country:US
Practice Address - Phone:563-359-4446
Practice Address - Fax:563-359-0381
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16931Medicare ID - Type Unspecified
IAV01265Medicare UPIN