Provider Demographics
NPI:1174840474
Name:UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES INC
Other - Org Name:UI HEALTH CARE - RIVER CROSSING OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROTEXTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-7642
Mailing Address - Street 1:2941 SIERRA CT SW
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8503
Mailing Address - Country:US
Mailing Address - Phone:319-337-7642
Mailing Address - Fax:319-339-1449
Practice Address - Street 1:3056 RIVER CROSSING COURT
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:IA
Practice Address - Zip Code:52327-4727
Practice Address - Country:US
Practice Address - Phone:319-467-8335
Practice Address - Fax:319-467-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier