Provider Demographics
NPI:1538139357
Name:VIRDI EYE CLINIC OF IOWA, P.C.
Entity Type:Organization
Organization Name:VIRDI EYE CLINIC OF IOWA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVANEET
Authorized Official - Middle Name:SC
Authorized Official - Last Name:BORISUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-264-3414
Mailing Address - Street 1:315 PARHAM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2604
Mailing Address - Country:US
Mailing Address - Phone:563-264-3414
Mailing Address - Fax:563-264-3416
Practice Address - Street 1:315 PARHAM ST
Practice Address - Street 2:SUITE A
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2604
Practice Address - Country:US
Practice Address - Phone:563-264-3414
Practice Address - Fax:563-264-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0270728Medicaid
IA0270728Medicaid