Provider Demographics
NPI:1053465260
Name:PARKWAY OPTICAL INC
Entity Type:Organization
Organization Name:PARKWAY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:TATRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-225-6980
Mailing Address - Street 1:2101 WESTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1596
Mailing Address - Country:US
Mailing Address - Phone:515-225-6980
Mailing Address - Fax:515-225-8031
Practice Address - Street 1:2101 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1596
Practice Address - Country:US
Practice Address - Phone:515-225-6980
Practice Address - Fax:515-225-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291420001Medicare NSC