1194998658 NPI number — THE CHRISTIAN EYE CLINIC, PLC

Table of content: (NPI 1194998658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194998658 NPI number — THE CHRISTIAN EYE CLINIC, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHRISTIAN EYE CLINIC, PLC
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:
1194998658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50323-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-333-3333
Provider Business Mailing Address Fax Number:
515-283-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7011 DOUGLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-333-3333
Provider Business Practice Location Address Fax Number:
515-362-7933
Provider Enumeration Date:
04/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHENOUDA
Authorized Official First Name:
EMAD
Authorized Official Middle Name:
RAGHEB
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-333-3333

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  33949 , 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)

  • Identifier: 1229203 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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