Provider Demographics
NPI:1255330460
Name:IOWA EYE INSTITUTE, P.C.
Entity Type:Organization
Organization Name:IOWA EYE INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-262-8878
Mailing Address - Street 1:1721 W 18TH ST
Mailing Address - Street 2:BOX 420
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2827
Mailing Address - Country:US
Mailing Address - Phone:712-262-8878
Mailing Address - Fax:712-262-8807
Practice Address - Street 1:1721 W 18TH ST
Practice Address - Street 2:BOX 420
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2827
Practice Address - Country:US
Practice Address - Phone:712-262-8878
Practice Address - Fax:712-262-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0216470001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0216470001Medicare NSC