1770555971 NPI number — MORAN EYE CENTER PC

Table of content: (NPI 1770555971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770555971 NPI number — MORAN EYE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORAN EYE CENTER PC
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:
1770555971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 HAMILTON BLVD
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-252-4333
Provider Business Mailing Address Fax Number:
712-252-1633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 HAMILTON BLVD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-252-4333
Provider Business Practice Location Address Fax Number:
712-252-1633
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORAN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DOCTOR PHYSICIAN
Authorized Official Telephone Number:
712-252-4333

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25860 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: 19909 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0244913 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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