Provider Demographics
NPI:1285618496
Name:CEDAR VALLEY OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:CEDAR VALLEY OPHTHALMOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-433-3000
Mailing Address - Street 1:2515 CYCLONE DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9746
Mailing Address - Country:US
Mailing Address - Phone:319-433-3000
Mailing Address - Fax:319-232-1155
Practice Address - Street 1:2515 CYCLONE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9746
Practice Address - Country:US
Practice Address - Phone:319-433-3000
Practice Address - Fax:319-232-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02050152W00000X
IA24873207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0427898Medicaid
IACE7549OtherRAILROAD MEDICARE
IAI7718Medicare PIN
IA0140210001Medicare NSC