MEDICARE: THE CHRISTIAN EYE CLINIC, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	33949	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194998658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHRISTIAN EYE CLINIC, PLC

Provider Business Mailing Address
First Line	:	PO BOX 7703
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50323-7703
Country	:	US
Telephone Number	:	515-333-3333
Fax Number	:	515-283-2020

Provider Business Practice Location Address
First Line	:	7011 DOUGLAS AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-3223
Country	:	US
Telephone Number	:	515-333-3333
Fax Number	:	515-362-7933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EMAD RAGHEB SHENOUDA
Credential	:	MD
Telephone Number	:	515-333-3333

Provider Enumeration Date	:	04/05/2008
Last Update Date	:	11/03/2014

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