Provider Demographics
NPI:1184954463
Name:WILLIAM R. ADLER OD PC
Entity type:Organization
Organization Name:WILLIAM R. ADLER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-932-7614
Mailing Address - Street 1:P.O. BOX 100
Mailing Address - Street 2:6584 165TH ST.
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531
Mailing Address - Country:US
Mailing Address - Phone:641-932-7614
Mailing Address - Fax:641-932-3372
Practice Address - Street 1:6584 165TH ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531
Practice Address - Country:US
Practice Address - Phone:641-932-7614
Practice Address - Fax:641-932-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1561152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0091058Medicaid
IA0357130001Medicare NSC
IAT00004Medicare UPIN
IA09105Medicare PIN