Provider Demographics
NPI:1063447217
Name:IOWA EYE PROSTHETICS INC
Entity Type:Organization
Organization Name:IOWA EYE PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BULGARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:BCO FASO BA
Authorized Official - Phone:319-354-3434
Mailing Address - Street 1:625 FIRST AVENUE
Mailing Address - Street 2:STE 200
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-354-3434
Mailing Address - Fax:319-354-3465
Practice Address - Street 1:625 FIRST AVENUE
Practice Address - Street 2:STE 200
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-354-3434
Practice Address - Fax:319-354-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0128413Medicaid
50796OtherBCBS
63648OtherBCBS OF KS
A001983OtherCHAMPUS
12841OtherBCBS
40219IOOtherBCBS OF MN
50796OtherBCBS