Provider Demographics
NPI:1831201102
Name:MCCARDLE, BRENDA SUE LOVIK (OD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SUE LOVIK
Last Name:MCCARDLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:LOVIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4151 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-7346
Mailing Address - Country:US
Mailing Address - Phone:641-423-8431
Mailing Address - Fax:641-423-8433
Practice Address - Street 1:4151 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-7346
Practice Address - Country:US
Practice Address - Phone:641-423-8431
Practice Address - Fax:641-423-8433
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56401OtherBLUE CROSS & BLUE SHIELD
IAU69808Medicare UPIN
IAI8280Medicare PIN