Healthcare Provider Details

I. General information

NPI: 1285682229
Provider Name (Legal Business Name): ASSOCIATED OPHTHALMOLOGISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PLEASANT ST STE 202
DES MOINES IA
50309-1414
US

IV. Provider business mailing address

1212 PLEASANT ST STE 202
DES MOINES IA
50309-1414
US

V. Phone/Fax

Practice location:
  • Phone: 515-288-8828
  • Fax: 515-288-4888
Mailing address:
  • Phone: 515-288-8828
  • Fax: 515-288-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JAMES VERSACKAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 515-243-1580