1811184252 NPI number — EYECARE ASSOCIATES, P.C.

Table of content: (NPI 1811184252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811184252 NPI number — EYECARE ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE 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:
1811184252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50250-0328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-523-1300
Provider Business Mailing Address Fax Number:
515-523-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 SW 7TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50250-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-523-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2007

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:
515-523-1300

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1166322 , 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: 1147579 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1166322 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1062166 , 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: P00230147 . This is a "RAILROAD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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