1205983897 NPI number — IOWA EYE PROSTHETICS, INC.

Table of content: (NPI 1205983897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205983897 NPI number — IOWA EYE PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA EYE PROSTHETICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205983897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 1ST AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CORALVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52241-2101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-354-3434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CORALVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52241-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-354-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BULGARELLI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT, OCULARIST
Authorized Official Telephone Number:
319-354-3434

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  081105-08 CERT# , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A001983 . This is a "CHAMPUS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 50796 . This is a "BC-BS O & P" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0128413 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40219IO . This is a "BC-BS OF MN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 63648 . This is a "BC-BS OF KS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 12841 . This is a "BC-BS DME" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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