Provider Demographics
NPI:1366416612
Name:MAXWELL, PAUL H (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:MAXWELL
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:515-225-8002
Practice Address - Street 1:209 E 1ST ST
Practice Address - Street 2:#100
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-1847
Practice Address - Country:US
Practice Address - Phone:515-964-4239
Practice Address - Fax:515-964-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45272OtherBLUE CROSS
IA1191759Medicaid
IA1191759Medicaid
IA45272OtherBLUE CROSS