Provider Demographics
NPI:1912564022
Name:LATNER, DARA (OD)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:LATNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 GOLD RUSH RD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-8562
Mailing Address - Country:US
Mailing Address - Phone:402-253-7439
Mailing Address - Fax:
Practice Address - Street 1:406 1ST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1706
Practice Address - Country:US
Practice Address - Phone:712-527-4468
Practice Address - Fax:712-527-9458
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist