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General NPI Number Information
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NPI Number | 1821335167
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE ASSOCIATES OF EASTERN IOWA VINTON PC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 1113 W 3RD ST BOX 397
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City | VINTON
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State | IA
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Zip | 52349
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Country | US
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Telephone | 319-472-3848
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Fax | 319-472-3192
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Provider Business Mailing Address
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Address Line | 1113 W 3RD ST
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City | VINTON
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State | IA
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Zip | 52349
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Country | US
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Telephone | 319-472-3848
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Fax | 319-472-3192
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. SHAWN D BEILBY
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Credential | O.D.
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Telephone | 319-472-3848
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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 | IA 02350
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License Number State | IA
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