Provider Demographics
NPI:1528329869
Name:INGRAM, DREW A (OD)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:A
Last Name:INGRAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3725 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3410
Mailing Address - Country:US
Mailing Address - Phone:515-279-2020
Mailing Address - Fax:515-255-8002
Practice Address - Street 1:3725 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3410
Practice Address - Country:US
Practice Address - Phone:515-279-2020
Practice Address - Fax:515-255-8002
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA002551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist