Provider Demographics
NPI:1083684211
Name:EYE CARE PAVILION PLC
Entity Type:Organization
Organization Name:EYE CARE PAVILION PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSSOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-324-2020
Mailing Address - Street 1:4310 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3039
Mailing Address - Country:US
Mailing Address - Phone:563-324-2020
Mailing Address - Fax:563-323-0949
Practice Address - Street 1:4310 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3039
Practice Address - Country:US
Practice Address - Phone:563-324-2020
Practice Address - Fax:563-323-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0448712Medicaid
IA37835OtherBCBS OF IOWA
IAI14295Medicare PIN
IA37835OtherBCBS OF IOWA