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General NPI Number Information
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NPI Number | 1205983897
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Entity Type | Organization
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Legal Business Name | IOWA EYE PROSTHETICS, INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 625 1ST AVE SUITE 200
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City | CORALVILLE
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State | IA
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Zip | 52241-2101
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Country | US
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Telephone | 319-354-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 625 1ST AVE SUITE 200
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City | CORALVILLE
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State | IA
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Zip | 52241-2101
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Country | US
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Telephone | 319-354-3434
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, OCULARIST
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Name | MR. DAVID MICHAEL BULGARELLI
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Credential | BA, BCO, FASO
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Telephone | 319-354-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 081105-08 CERT#
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License Number State | FL
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