Provider Demographics
NPI:1053390328
Name:MIDDENDORP, LORAYNE CAROLINE (OD)
Entity type:Individual
Prefix:DR
First Name:LORAYNE
Middle Name:CAROLINE
Last Name:MIDDENDORP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LORAYNE
Other - Middle Name:C
Other - Last Name:SIETSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:600 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-2459
Mailing Address - Country:US
Mailing Address - Phone:712-540-7832
Mailing Address - Fax:
Practice Address - Street 1:2513 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4045
Practice Address - Country:US
Practice Address - Phone:712-252-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist