Healthcare Provider Details

I. General information

NPI: 1851960652
Provider Name (Legal Business Name): HARLAN EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MARKET ST
HARLAN IA
51537-1412
US

IV. Provider business mailing address

105 GAUL DR
SERGEANT BLUFF IA
51054-8963
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RACHEL VANDEKOP
Title or Position: PRACTICE MANAGER
Credential:
Phone: 712-490-4658