Provider Demographics
NPI:1205862539
Name:MARSHALLTOWN VISION P.C.
Entity Type:Organization
Organization Name:MARSHALLTOWN VISION P.C.
Other - Org Name:EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHADDERDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-752-1511
Mailing Address - Street 1:501 E MAIN ST
Mailing Address - Street 2:P.O. BOX 773
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1930
Mailing Address - Country:US
Mailing Address - Phone:641-752-1511
Mailing Address - Fax:641-753-8773
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-0773
Practice Address - Country:US
Practice Address - Phone:641-752-1511
Practice Address - Fax:641-753-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5961790001Medicare NSC
IAI20101Medicare PIN