Healthcare Provider Details

I. General information

NPI: 1851569164
Provider Name (Legal Business Name): INSIGHT VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12871 UNIVERSITY AVE SUITE 140
CLIVE IA
50325
US

IV. Provider business mailing address

12871 UNIVERSITY AVE SUITE 140
CLIVE IA
50325
US

V. Phone/Fax

Practice location:
  • Phone: 515-221-9195
  • Fax: 515-221-9196
Mailing address:
  • Phone: 515-221-9195
  • Fax: 515-221-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2216
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier1266767
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: DR. ETHAN EVERETT HUISMAN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 515-221-9195