Healthcare Provider Details

I. General information

NPI: 1801887484
Provider Name (Legal Business Name): EYECARE ASSOCIATES OF SOUTHWEST IOWA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E WASHINGTON ST
CLARINDA IA
51632-1611
US

IV. Provider business mailing address

116 E WASHINGTON ST
CLARINDA IA
51632-1611
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-6513
  • Fax: 712-542-2274
Mailing address:
  • Phone: 712-542-6513
  • Fax: 712-542-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: GREGORY L SAMUELSON
Title or Position: SECRETARY/TREASURER/OWNER
Credential: O.D.
Phone: 712-542-6513