Provider Demographics
NPI:1336102052
Name:VISION PARK FAMILY EYE CARE, LLP
Entity Type:Organization
Organization Name:VISION PARK FAMILY EYE CARE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-270-2490
Mailing Address - Street 1:2699 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4309
Mailing Address - Country:US
Mailing Address - Phone:515-270-2490
Mailing Address - Fax:515-270-2494
Practice Address - Street 1:2699 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4309
Practice Address - Country:US
Practice Address - Phone:515-270-2490
Practice Address - Fax:515-270-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1965152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410035605OtherRAILROAD MEDICARE
IAU21001Medicare UPIN
IA48179Medicare PIN
IA0316130001Medicare NSC