Healthcare Provider Details

I. General information

NPI: 1750362174
Provider Name (Legal Business Name): BOONE VISION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 STORY ST
BOONE IA
50036-2833
US

IV. Provider business mailing address

621 STORY ST
BOONE IA
50036-2833
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-2973
  • Fax: 515-432-1811
Mailing address:
  • Phone: 515-432-2973
  • Fax: 515-432-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberIA1854
License Number StateIA

VIII. Authorized Official

Name: DR. JEFFREY CRAIG ANDERSON
Title or Position: OWNER OPTOMETRIST
Credential: OD
Phone: 515-432-2973