Healthcare Provider Details

I. General information

NPI: 1821223371
Provider Name (Legal Business Name): HEARTLAND EYE CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N B ST
FAIRFIELD IA
52556-2944
US

IV. Provider business mailing address

205 N B ST
FAIRFIELD IA
52556-2944
US

V. Phone/Fax

Practice location:
  • Phone: 641-472-7175
  • Fax: 641-472-7214
Mailing address:
  • Phone: 641-472-7175
  • Fax: 641-472-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN KIM SWAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 641-682-8571