Provider Demographics
NPI:1487603684
Name:EYE CARE OF IOWA PC
Entity type:Organization
Organization Name:EYE CARE OF IOWA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-287-5565
Mailing Address - Street 1:200 ARMY POST RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315
Mailing Address - Country:US
Mailing Address - Phone:515-287-5565
Mailing Address - Fax:515-287-2540
Practice Address - Street 1:200 ARMY POST RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315
Practice Address - Country:US
Practice Address - Phone:515-287-5565
Practice Address - Fax:515-287-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0416883Medicaid
CN6633Medicare PIN
0315220004Medicare NSC
IA0416883Medicaid