=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144657354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION CARE CLINIC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2013
-----------------------------------------------------
Last Update Date | 10/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S 29TH ST
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51501-3449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-325-4999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S 29TH ST
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51501-3449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-325-4999
-----------------------------------------------------
Fax | 712-256-4073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT ALAN BOWKER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 712-263-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------