Provider Demographics
NPI:1497863559
Name:NORTH IOWA EYE CLINIC, P.C.
Entity Type:Organization
Organization Name:NORTH IOWA EYE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-423-8861
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1877
Mailing Address - Country:US
Mailing Address - Phone:641-423-8861
Mailing Address - Fax:641-423-0727
Practice Address - Street 1:3121 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1581
Practice Address - Country:US
Practice Address - Phone:641-423-8861
Practice Address - Fax:641-423-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24594OtherPTAN