Healthcare Provider Details

I. General information

NPI: 1215210737
Provider Name (Legal Business Name): VISION CARE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MAIN ST
MOVILLE IA
51039-7814
US

IV. Provider business mailing address

223 MAIN ST
MOVILLE IA
51039-7814
US

V. Phone/Fax

Practice location:
  • Phone: 712-873-3440
  • Fax: 712-873-3442
Mailing address:
  • Phone: 712-873-3440
  • Fax: 712-873-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KEITH A SCHRUNK
Title or Position: CO-PRESIDENT
Credential: OD
Phone: 712-873-3440