Healthcare Provider Details

I. General information

NPI: 1932103611
Provider Name (Legal Business Name): DRIESEN EYE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N MAIN AVE
SIOUX CENTER IA
51250-1852
US

IV. Provider business mailing address

PO BOX 20
SIOUX CENTER IA
51250-0020
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-2051
  • Fax: 712-722-4531
Mailing address:
  • Phone: 712-722-2051
  • Fax: 712-722-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1974
License Number StateIA

VIII. Authorized Official

Name: MRS. SHAWN MEYERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 712-722-2051