Provider Demographics
NPI:1861590325
Name:ROBERT R NEGRETE OD PC
Entity type:Organization
Organization Name:ROBERT R NEGRETE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEGRETE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-461-0038
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5844
Mailing Address - Country:US
Mailing Address - Phone:641-753-5042
Mailing Address - Fax:641-753-5292
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5844
Practice Address - Country:US
Practice Address - Phone:641-753-5042
Practice Address - Fax:641-753-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2015T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4110973Medicaid
IA53102OtherDR NEGRETE BCBS #
IAP00291954OtherDR NEGRETE RR MEDICARE #
IAI16999Medicare PIN
IA53102OtherDR NEGRETE BCBS #
IA4110973Medicaid