Provider Demographics
NPI:1275198251
Name:FOUREYES PLLC
Entity Type:Organization
Organization Name:FOUREYES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-722-1270
Mailing Address - Street 1:1423 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1223
Mailing Address - Country:US
Mailing Address - Phone:712-451-6540
Mailing Address - Fax:712-451-6542
Practice Address - Street 1:1423 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1223
Practice Address - Country:US
Practice Address - Phone:712-451-6540
Practice Address - Fax:712-451-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7771410001OtherDMERC D