Provider Demographics
NPI:1679544696
Name:MORTENSON, RACHEL V (OD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:V
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2448
Mailing Address - Country:US
Mailing Address - Phone:319-283-3628
Mailing Address - Fax:319-283-5638
Practice Address - Street 1:208 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2448
Practice Address - Country:US
Practice Address - Phone:319-283-3628
Practice Address - Fax:319-283-5638
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1262402Medicaid
IA50095OtherDAVIS VISION
IA47097OtherWELLMARK BC/BS
IA20049273201OtherJOHN DEERE HEALTH CHOICE
IA20049273201OtherJOHN DEERE HEALTH CHOICE
IAI13245Medicare PIN