Provider Demographics
NPI:1750402541
Name:FURMAN, DONALD WALLACE (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WALLACE
Last Name:FURMAN
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:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:BRITT
Mailing Address - State:IA
Mailing Address - Zip Code:50423-0066
Mailing Address - Country:US
Mailing Address - Phone:641-843-3841
Mailing Address - Fax:641-843-4686
Practice Address - Street 1:45 STATE ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1108
Practice Address - Country:US
Practice Address - Phone:641-923-3737
Practice Address - Fax:641-923-3254
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17592OtherDWF BCBS GARNER
IA0113142Medicaid
IA0206150002OtherBRITT DMERC
IA17589OtherDWF BCBS BRITT
IA0206150001OtherGARNER DMERC
IA1113142Medicaid
IA0206150001OtherGARNER DMERC
IAI7523Medicare ID - Type UnspecifiedDWF GARNER MEDICARE #
IA17589OtherDWF BCBS BRITT