1992003677 NPI number — VIRDI EYE CLINIC OF IOWA

Table of content: (NPI 1992003677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992003677 NPI number — VIRDI EYE CLINIC OF IOWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRDI EYE CLINIC OF IOWA
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:
1992003677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 PARHAM ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MUSCATINE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52761-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 13TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52732-3479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-219-8044
Provider Business Practice Location Address Fax Number:
563-219-8027
Provider Enumeration Date:
03/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BORISUTH
Authorized Official First Name:
NAVANEET
Authorized Official Middle Name:
S.C.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
563-264-3414

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  39332 , 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: 0270728 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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