MEDICARE: WOLFE CLINIC EYE CENTERS, LC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1760534069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOLFE CLINIC EYE CENTERS, LC

Provider Business Mailing Address
First Line	:	309 E CHURCH ST
Second Line	:
City	:	MARSHALLTOWN
State	:	IA
Zip	:	50158-2946
Country	:	US
Telephone Number	:	641-754-6200
Fax Number	:	712-662-7311

Provider Business Practice Location Address
First Line	:	202 S 6TH ST
Second Line	:
City	:	SAC CITY
State	:	IA
Zip	:	50583-2242
Country	:	US
Telephone Number	:	712-662-7777
Fax Number	:	712-662-7311

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	DAVID MOENCH
Credential	:
Telephone Number	:	515-240-8721

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/29/2024

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