Provider Demographics
NPI:1487796017
Name:PAPKE, DIANE LEA (OD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LEA
Last Name:PAPKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LEA
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:251 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1759
Mailing Address - Country:US
Mailing Address - Phone:563-285-4001
Mailing Address - Fax:563-285-6121
Practice Address - Street 1:251 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1759
Practice Address - Country:US
Practice Address - Phone:563-285-4001
Practice Address - Fax:563-285-6121
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161752Medicaid
IA0161752Medicaid
IA16175Medicare ID - Type Unspecified