1063447217 NPI number — IOWA EYE PROSTHETICS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063447217 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:
1063447217
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 FIRST AVENUE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
CORALVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-354-3434
Provider Business Mailing Address Fax Number:
319-354-3465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 FIRST AVENUE
Provider Second Line Business Practice Location Address:
STE 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
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:
319-354-3465
Provider Enumeration Date:
07/12/2006

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: 156FX1700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




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