Organization
WAHL OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT GLEN WAHL (OWNER)
(712) 322-4554
Entity
Organization
Contact information
Practice address
2201 W BROADWAY, SUITE 2, COUNCIL BLUFFS, IA 51501-3605
(712) 322-4554
(712) 322-2340
Mailing address
2201 W BROADWAY, SUITE 2, COUNCIL BLUFFS, IA 51501-3605
(712) 322-4554
(712) 322-2340
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1511
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134080
—
IA
Enumeration date
10/10/2006
Last updated
08/22/2020
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