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General NPI Number Information
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NPI Number | 1619145281
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE CENTER, PC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 4660 86TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-1026
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Country | US
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Telephone | 515-727-6340
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Fax | 515-727-5109
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Provider Business Mailing Address
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Address Line | 4660 86TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-1026
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Country | US
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Telephone | 515-727-6340
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Fax | 515-727-5109
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WENDIANNE M WILSON
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Credential | O.D.
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Telephone | 515-727-6340
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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 | 2001
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License Number State | IA
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