Provider Demographics
NPI:1114386232
Name:KORVER EYE CARE INC
Entity Type:Organization
Organization Name:KORVER EYE CARE INC
Other - Org Name:KORVER EYE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KORVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-276-2323
Mailing Address - Street 1:3535 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4749
Mailing Address - Country:US
Mailing Address - Phone:712-276-2323
Mailing Address - Fax:712-274-9986
Practice Address - Street 1:3535 SOUTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4749
Practice Address - Country:US
Practice Address - Phone:712-276-2323
Practice Address - Fax:712-274-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA 2181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0016758Medicaid
IA0016758Medicaid