Provider Demographics
NPI:1588668263
Name:DRIESEN, PEGGY SUE (OD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:SUE
Last Name:DRIESEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-0020
Mailing Address - Country:US
Mailing Address - Phone:712-722-2051
Mailing Address - Fax:712-722-4531
Practice Address - Street 1:318 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1852
Practice Address - Country:US
Practice Address - Phone:712-722-2051
Practice Address - Fax:712-722-4531
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACG1306OtherRAILROAD MEDICARE
IA44795OtherBC/BS
IA2032OtherIA LICENSE
IA0121533Medicaid
SD9200560Medicaid
SD9200560Medicaid
IA1805662OtherIA DEA
IAMD0149333OtherFED DEA
IACG1306OtherRAILROAD MEDICARE
IA1805662OtherIA DEA