Individual
GREGORY L SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
116 E WASHINGTON ST, CLARINDA, IA 51632-1611
(712) 542-6513
(712) 542-2274
Mailing address
401 N 18TH ST, CLARINDA, IA 51632-1524
(712) 542-5461
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01841
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07423
BCBS
IA
01
—
07428
BCBS
IA
05
—
100249544-00
—
NE
01
—
1487645156
BLOCK VISION
—
01
—
22-00001
UHC
—
05
—
2262956
—
IA
01
—
24362
MIDLANDS CHOICE
—
01
—
930454
EYEMED
—
Enumeration date
11/02/2005
Last updated
08/03/2012
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