Provider Demographics
NPI:1043421712
Name:CARROLL EYE CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:CARROLL EYE CARE ASSOCIATES PC
Other - Org Name:CARROLL EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DILLEHAY
Authorized Official - Suffix:
Authorized Official - Credentials:CPOT
Authorized Official - Phone:712-792-9687
Mailing Address - Street 1:805 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2369
Mailing Address - Country:US
Mailing Address - Phone:712-792-9687
Mailing Address - Fax:712-792-9828
Practice Address - Street 1:805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2369
Practice Address - Country:US
Practice Address - Phone:712-792-9687
Practice Address - Fax:712-792-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1922042845Medicare PIN
IA1326063173Medicare PIN
IA0223690001Medicare NSC