Provider Demographics
NPI:1497948616
Name:HAWKEYE CLINIC OF SERGEANT BLUFF, PC
Entity Type:Organization
Organization Name:HAWKEYE CLINIC OF SERGEANT BLUFF, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:UHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-943-9400
Mailing Address - Street 1:105 GAUL DR
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 GAUL DR
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8963
Practice Address - Country:US
Practice Address - Phone:712-943-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty