Individual
DR. MERVIN R HASSEBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1107 9TH AVE, DE WITT, IA 52742-0050
(563) 659-8141
(563) 659-2121
Mailing address
PO BOX 50, DE WITT, IA 52742-0050
(563) 659-8141
(563) 659-2121
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1676
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156042
—
IA
01
—
410036929
LOWDEN RAILROAD RETIREMNT
IA
01
—
580000760
RAILROAD RETIREMENT
IA
Enumeration date
02/20/2006
Last updated
05/12/2010
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