Provider Demographics
NPI:1063651859
Name:EYEPLAN, INC.
Entity Type:Organization
Organization Name:EYEPLAN, INC.
Other - Org Name:DES MOINES OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEHAAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-628-9225
Mailing Address - Street 1:823 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1603
Mailing Address - Country:US
Mailing Address - Phone:641-628-9225
Mailing Address - Fax:641-628-8698
Practice Address - Street 1:3945 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1309
Practice Address - Country:US
Practice Address - Phone:515-276-2288
Practice Address - Fax:515-276-2567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1682152W00000X
IA1831152W00000X
IA1975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1790763811Medicaid
IA1083692214Medicaid
IA1750369971Medicaid