Provider Demographics
NPI:1528020773
Name:VISION CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:VISION CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMOTRIST
Authorized Official - Prefix:
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-732-3233
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-1407
Mailing Address - Country:US
Mailing Address - Phone:712-732-3233
Mailing Address - Fax:712-732-1866
Practice Address - Street 1:600 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1845
Practice Address - Country:US
Practice Address - Phone:712-732-3233
Practice Address - Fax:712-732-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1214304Medicaid
IA1214304Medicaid
0196950001Medicare NSC