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General NPI Number Information
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NPI Number | 1033637079
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Entity Type | Organization
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Legal Business Name | DOMINO EYE CARE, PLLC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2510 SW WHITE BIRCH DR STE 5
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City | ANKENY
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State | IA
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Zip | 50023-7171
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Country | US
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Telephone | 515-964-5427
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Fax | 515-964-3277
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Provider Business Mailing Address
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Address Line | 2510 SW WHITE BIRCH DR STE 5
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City | ANKENY
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State | IA
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Zip | 50023-7171
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Country | US
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Telephone | 515-964-5427
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Fax | 515-964-3277
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Authorized Official
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Title or Position | OWNER
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Name | LISA G DOMINO
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Credential | OD
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Telephone | 515-964-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002438
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License Number State | IA
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