Individual
MARK LEROY BOTTELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1001 73RD ST, VISION CENTER, WINDSOR HEIGHTS, IA 50324-1311
(515) 274-6452
(515) 274-6306
Mailing address
1001 73RD ST, VISION CENTER, WINDSOR HEIGHTS, IA 50324-1311
(515) 274-6452
(515) 274-6306
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01684
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
238377
COVENTRY
IA
Enumeration date
01/08/2008
Last updated
07/13/2009
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