Provider Demographics
NPI:1982388179
Name:HUSIDIC, DALILA (OD)
Entity Type:Individual
Prefix:
First Name:DALILA
Middle Name:
Last Name:HUSIDIC
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 1:4902 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8010
Mailing Address - Country:US
Mailing Address - Phone:319-290-1384
Mailing Address - Fax:
Practice Address - Street 1:999 HOME PLZ STE 100
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4822
Practice Address - Country:US
Practice Address - Phone:319-236-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist