Provider Demographics
NPI:1225189400
Name:WOLFE CLINIC EYE CENTERS, LC
Entity Type:Organization
Organization Name:WOLFE CLINIC EYE CENTERS, LC
Other - Org Name:WOLFE FAMILY VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-754-6200
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:641-754-6245
Practice Address - Street 1:100 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-4201
Practice Address - Country:US
Practice Address - Phone:641-472-6151
Practice Address - Fax:641-472-3630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOLFE CLINIC EYE CENTERS LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-15
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1191400001Medicare NSC