Provider Demographics
NPI:1316507858
Name:SMERUD, MORGAN LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:LEIGH
Last Name:SMERUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1839 ONEILL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-7921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2073
Practice Address - Country:US
Practice Address - Phone:563-568-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist