Provider Demographics
NPI:1043598824
Name:NW IA VISION PLLC
Entity Type:Organization
Organization Name:NW IA VISION PLLC
Other - Org Name:SIBLEY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:N
Authorized Official - Last Name:KUNZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-754-4621
Mailing Address - Street 1:228 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-1801
Mailing Address - Country:US
Mailing Address - Phone:712-754-4621
Mailing Address - Fax:712-754-2762
Practice Address - Street 1:228 9TH ST
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1801
Practice Address - Country:US
Practice Address - Phone:712-754-4621
Practice Address - Fax:712-754-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty