Healthcare Provider Details

I. General information

NPI: 1437118668
Provider Name (Legal Business Name): WOLFE CLINIC EYE CENTERS LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 6TH ST
SAC CITY IA
50583-2242
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 712-662-7311
  • Fax:
Mailing address:
  • Phone: 641-754-6200
  • Fax: 641-754-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOENCH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 515-240-8721