Provider Demographics
NPI:1467501981
Name:TKC OPTICAL
Entity Type:Organization
Organization Name:TKC OPTICAL
Other - Org Name:EXACT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VANDERLEI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-732-7624
Mailing Address - Street 1:1801 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-2118
Mailing Address - Country:US
Mailing Address - Phone:712-732-7624
Mailing Address - Fax:712-732-7627
Practice Address - Street 1:100 E MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1813
Practice Address - Country:US
Practice Address - Phone:712-732-7624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
19004OtherAVESIS
NE1143-03OtherEYEMED
IA21629OtherSPECTERA
NE1143-03OtherEYEMED