Healthcare Provider Details

I. General information

NPI: 1972323301
Provider Name (Legal Business Name): VANCE THOMPSON VISION SURGERY CENTER CEDAR RAPIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 H AVE NE
CEDAR RAPIDS IA
52402-4624
US

IV. Provider business mailing address

3101 W 57TH ST
SIOUX FALLS SD
57108-3162
US

V. Phone/Fax

Practice location:
  • Phone: 800-473-3968
  • Fax:
Mailing address:
  • Phone: 605-371-7100
  • Fax: 605-371-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK ALLEN SCHARNBERG
Title or Position: CFO
Credential:
Phone: 605-359-9155