Healthcare Provider Details

I. General information

NPI: 1063447217
Provider Name (Legal Business Name): IOWA EYE PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FIRST AVENUE STE 200
CORALVILLE IA
52241
US

IV. Provider business mailing address

625 FIRST AVENUE STE 200
CORALVILLE IA
52241
US

V. Phone/Fax

Practice location:
  • Phone: 319-354-3434
  • Fax: 319-354-3465
Mailing address:
  • Phone: 319-354-3434
  • Fax: 319-354-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MICHAEL BULGARELLI
Title or Position: PRESIDENT OCULARIST
Credential: BCO FASO BA
Phone: 319-354-3434