Provider Demographics
NPI:1427027176
Name:NEWTON EYE CLINIC, P.C.
Entity Type:Organization
Organization Name:NEWTON EYE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANISCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-792-7375
Mailing Address - Street 1:111 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3715
Mailing Address - Country:US
Mailing Address - Phone:641-792-7375
Mailing Address - Fax:641-792-7525
Practice Address - Street 1:111 1ST AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3715
Practice Address - Country:US
Practice Address - Phone:641-792-7375
Practice Address - Fax:641-792-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0124404Medicaid
IA0124404Medicaid
IA12440Medicare PIN