Healthcare Provider Details

I. General information

NPI: 1588849848
Provider Name (Legal Business Name): VISION CARE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 17TH ST
BLAIR NE
68008-2055
US

IV. Provider business mailing address

210 S 17TH ST
BLAIR NE
68008-2055
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-2119
  • Fax: 402-426-2120
Mailing address:
  • Phone: 402-426-2119
  • Fax: 402-426-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number01624
License Number StateIA

VIII. Authorized Official

Name: DR. SCOTT A BOWKER
Title or Position: CO PRESIDENT
Credential: OD
Phone: 712-263-2020