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General NPI Number Information
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NPI Number | 1730133885
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Entity Type | Organization
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Legal Business Name | CENTRAL VISION CENTER OF OSKALOOSA P.C.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 119 1ST AVE W
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City | OSKALOOSA
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State | IA
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Zip | 52577-3243
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Country | US
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Telephone | 641-673-7708
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Fax | 641-673-0979
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Provider Business Mailing Address
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Address Line | 119 1ST AVE W
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City | OSKALOOSA
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State | IA
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Zip | 52577-3243
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Country | US
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Telephone | 641-673-7708
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Fax | 641-673-0979
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA SHOUP
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Credential | O.D.
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Telephone | 641-673-7708
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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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