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General NPI Number Information
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NPI Number | 1245423540
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Entity Type | Organization
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Legal Business Name | NORTH IOWA EYE CLINIC, P.C.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 401 VILLAGE LN
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City | MASON CITY
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State | IA
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Zip | 50401-9999
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Country | US
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Telephone | 641-423-8124
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Fax | 641-423-0727
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Provider Business Mailing Address
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Address Line | PO BOX 1877
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City | MASON CITY
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State | IA
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Zip | 50402-1877
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Country | US
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Telephone | 641-423-8124
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Fax | 641-423-0727
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUSAN KATHLEEN KLINE
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Credential | CPA
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Telephone | 641-423-8861
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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 |
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License Number State |
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