1487099545 NPI number — HUEBENER EYE CARE INC

Table of content: (NPI 1487099545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487099545 NPI number — HUEBENER EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUEBENER EYE CARE 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:
1487099545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 KOSER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52246-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-337-4268
Provider Business Mailing Address Fax Number:
319-752-2589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EYEDEAL OPTICAL
Provider Second Line Business Practice Location Address:
2644 PENNSYLVANIA AVENUE
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-557-0995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUEBENER
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
319-337-4268

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  01895 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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