1407988009 NPI number — IOWA EYECARE ASSOCIATES PC

Table of content: (NPI 1407988009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407988009 NPI number — IOWA EYECARE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA EYECARE ASSOCIATES 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:
6
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:
1407988009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 E CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALLTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50158-2946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-754-6200
Provider Business Mailing Address Fax Number:
641-754-6215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CEDAR FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50613-2382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-266-0345
Provider Business Practice Location Address Fax Number:
319-268-1327
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOENCH
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
641-754-6200

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18418 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0117267 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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