Healthcare Provider Details

I. General information

NPI: 1568997435
Provider Name (Legal Business Name): BOONE VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHELY OVERTON
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 515-432-2973