1154500171 NPI number — EYE CARE ASSOCIATES, P.C.

Table of content: (NPI 1154500171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154500171 NPI number — EYE CARE ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE ASSOCIATES, P.C.
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:
1154500171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUTHRIE CENTER
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50115-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-747-8207
Provider Business Mailing Address Fax Number:
515-465-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTHRIE CENTER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50115-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-747-8207
Provider Business Practice Location Address Fax Number:
515-465-5373
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCAULEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
515-465-4203

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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: 2062166 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00204355 . This is a "RAILROAD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2166322 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DN4532 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: P00620439 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2147579 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00230147 . This is a "RAILROAD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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