Provider Demographics
NPI:1285682229
Name:ASSOCIATED OPHTHALMOLOGISTS, PC
Entity Type:Organization
Organization Name:ASSOCIATED OPHTHALMOLOGISTS, PC
Other - Org Name:FAMILY EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VERSACKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-243-1580
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:STE 202
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1414
Mailing Address - Country:US
Mailing Address - Phone:515-288-8828
Mailing Address - Fax:515-288-4888
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:STE 202
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-288-8828
Practice Address - Fax:515-288-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0041798Medicaid
IA0041798Medicaid
IA=========OtherCOMMERCIAL