Provider Demographics
NPI:1285992362
Name:DOUGLAS C. SPYRISON, OD
Entity type:Organization
Organization Name:DOUGLAS C. SPYRISON, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPYRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-588-4651
Mailing Address - Street 1:1705 DELHI ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-5900
Mailing Address - Country:US
Mailing Address - Phone:563-588-4651
Mailing Address - Fax:563-557-1073
Practice Address - Street 1:1705 DELHI ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5900
Practice Address - Country:US
Practice Address - Phone:563-588-4651
Practice Address - Fax:563-557-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1760261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center