Healthcare Provider Details

I. General information

NPI: 1548215395
Provider Name (Legal Business Name): VISION CARE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E ERIE ST
MISSOURI VALLEY IA
51555-1619
US

IV. Provider business mailing address

308 E ERIE ST
MISSOURI VALLEY IA
51555-1619
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-4146
  • Fax: 712-642-3091
Mailing address:
  • Phone: 712-642-4146
  • Fax: 712-642-3091

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 A BOWKER
Title or Position: CO PRESIDENT
Credential: OD
Phone: 712-263-2020