Provider Demographics
NPI:1669788956
Name:MCDONALD OPTICAL DISPENSARY INC
Entity type:Organization
Organization Name:MCDONALD OPTICAL DISPENSARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-4995
Mailing Address - Street 1:16 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3912
Mailing Address - Country:US
Mailing Address - Phone:319-337-4995
Mailing Address - Fax:319-358-5707
Practice Address - Street 1:16 S CLINTON ST
Practice Address - Street 2:BOX 1940
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3912
Practice Address - Country:US
Practice Address - Phone:319-337-4995
Practice Address - Fax:319-358-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty