Provider Demographics
NPI: | 1336660968 |
---|---|
Name: | WARD VISION LLC |
Entity Type: | Organization |
Organization Name: | WARD VISION LLC |
Other - Org Name: | VALLEY EYE CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/OPTOMETRIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MATTHEW |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | WARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 515-217-9595 |
Mailing Address - Street 1: | 1019 SW 37TH CT |
Mailing Address - Street 2: | |
Mailing Address - City: | ANKENY |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50023-8308 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-556-5322 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2020 GRAND AVE |
Practice Address - Street 2: | |
Practice Address - City: | WEST DES MOINES |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50265-4200 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-223-1266 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-07-05 |
Last Update Date: | 2023-07-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 002560 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |