Provider Demographics
NPI:1518948231
Name:CARROLL EYE CLINIC PC
Entity Type:Organization
Organization Name:CARROLL EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:OSTRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-792-3318
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0669
Mailing Address - Country:US
Mailing Address - Phone:712-792-3318
Mailing Address - Fax:712-792-3319
Practice Address - Street 1:1236 HEIRES AVE
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3328
Practice Address - Country:US
Practice Address - Phone:712-792-3318
Practice Address - Fax:712-792-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0792283Medicaid
IA=========OtherVSP
IA=========OtherMEDICARE COMPLETE
IA=========OtherACCOUNTABLE HEALTH
IA0792283Medicaid
IA0792283Medicaid
IAI6866Medicare PIN
IA=========OtherACCOUNTABLE HEALTH