Healthcare Provider Details

I. General information

NPI: 1689910218
Provider Name (Legal Business Name): THE CHRISTIAN EYE CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2013
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 DOUGLAS AVE.
URBANDALE IA
50322-3223
US

IV. Provider business mailing address

PO BOX 7703
URBANDALE IA
50323-7703
US

V. Phone/Fax

Practice location:
  • Phone: 515-333-3333
  • Fax: 515-283-2020
Mailing address:
  • Phone: 515-333-3333
  • Fax: 515-283-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateIA

VIII. Authorized Official

Name: DR. EMAD R SHENOUDA
Title or Position: PRESIDENT
Credential: MD
Phone: 515-333-3333