Provider Demographics
NPI:1427292366
Name:DR OSCAR CORREDOR & ASSOCIATES
Entity type:Organization
Organization Name:DR OSCAR CORREDOR & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:CORREDOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-963-4404
Mailing Address - Street 1:2409 SE DELAWARE AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4470
Mailing Address - Country:US
Mailing Address - Phone:515-963-4404
Mailing Address - Fax:515-963-4406
Practice Address - Street 1:2409 SE DELAWARE AVE
Practice Address - Street 2:STE 104
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4470
Practice Address - Country:US
Practice Address - Phone:515-963-4404
Practice Address - Fax:515-963-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002444152W00000X
MO2003027013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275634800OtherNPI TYPE 1