Healthcare Provider Details

I. General information

NPI: 1457402224
Provider Name (Legal Business Name): WOLFE CLINIC EYE CENTERS, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BROAD ST
STORY CITY IA
50248-1200
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-6900
  • Fax: 515-733-2636
Mailing address:
  • Phone: 641-754-6200
  • Fax: 641-754-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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