Provider Demographics
NPI:1225093735
Name:EYECARE PARTNERS, P.C.
Entity Type:Organization
Organization Name:EYECARE PARTNERS, P.C.
Other - Org Name:PENN CENTRAL EYE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEHAAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-628-9225
Mailing Address - Street 1:823 FRANKLIN ST
Mailing Address - Street 2:UNIT 148
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1603
Mailing Address - Country:US
Mailing Address - Phone:641-628-9225
Mailing Address - Fax:641-628-8698
Practice Address - Street 1:823 FRANKLIN ST
Practice Address - Street 2:UNIT 148
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1603
Practice Address - Country:US
Practice Address - Phone:641-628-9225
Practice Address - Fax:641-628-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1169862Medicaid
IA26914Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IA1169862Medicaid