MEDICARE: VISION CARE CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42149719	OTHER	IA	COMMERCIAL & OTHER STATES
2	A004235	OTHER	IA	CHAMPUS
3	39891	OTHER	IA	WELLMARK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548215395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION CARE CLINIC PC

Provider Business Mailing Address
First Line	:	308 E ERIE ST
Second Line	:
City	:	MISSOURI VALLEY
State	:	IA
Zip	:	51555-1619
Country	:	US
Telephone Number	:	712-642-4146
Fax Number	:	712-642-3091

Provider Business Practice Location Address
First Line	:	308 E ERIE ST
Second Line	:
City	:	MISSOURI VALLEY
State	:	IA
Zip	:	51555-1619
Country	:	US
Telephone Number	:	712-642-4146
Fax Number	:	712-642-3091

Authorized Official
Title or Position	:	CO PRESIDENT
Name	:	DR. SCOTT A BOWKER
Credential	:	OD
Telephone Number	:	712-263-2020

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/18/2023

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Directions to “VISION CARE CLINIC PC ” Practice Location

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