Healthcare Provider Details

I. General information

NPI: 1144657354
Provider Name (Legal Business Name): VISION CARE CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 29TH ST
COUNCIL BLUFFS IA
51501-3449
US

IV. Provider business mailing address

200 S 29TH ST
COUNCIL BLUFFS IA
51501-3449
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-4999
  • Fax:
Mailing address:
  • Phone: 712-325-4999
  • Fax: 712-256-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT ALAN BOWKER
Title or Position: CO-PRESIDENT
Credential: O.D.
Phone: 712-263-2020