Provider Demographics
NPI:1003320706
Name:HAWKEYE CLINIC OF MARCUS, PC
Entity Type:Organization
Organization Name:HAWKEYE CLINIC OF MARCUS, PC
Other - Org Name:MARCUS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEKOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-943-9400
Mailing Address - Street 1:105 GAUL DR
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8963
Mailing Address - Country:US
Mailing Address - Phone:712-943-9400
Mailing Address - Fax:
Practice Address - Street 1:406 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCUS
Practice Address - State:IA
Practice Address - Zip Code:51035-7719
Practice Address - Country:US
Practice Address - Phone:712-943-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA73787OtherBLUE CROSS BLUE SHIELD