Provider Demographics
NPI:1083668206
Name:VISION CARE CLINIC PC
Entity Type:Organization
Organization Name:VISION CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-263-2020
Mailing Address - Street 1:201 N MAIN ST
Mailing Address - Street 2:BOX 399
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-0399
Mailing Address - Country:US
Mailing Address - Phone:712-263-2020
Mailing Address - Fax:712-263-4053
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-0399
Practice Address - Country:US
Practice Address - Phone:712-263-2020
Practice Address - Fax:712-263-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42149719OtherCOMMERCIAL & OTHER STATES
IA18020OtherWELLMARK
IA0218339Medicaid
IAAOO4235OtherCHAMPUS
IAAOO4235OtherCHAMPUS
IA0218339Medicaid
IACH2873Medicare PIN