Provider Demographics
NPI:1548215395
Name:VISION CARE CLINIC PC
Entity Type:Organization
Organization Name:VISION CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-263-2020
Mailing Address - Street 1:308 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1619
Mailing Address - Country:US
Mailing Address - Phone:712-642-4146
Mailing Address - Fax:712-642-3091
Practice Address - Street 1:308 E ERIE ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1619
Practice Address - Country:US
Practice Address - Phone:712-642-4146
Practice Address - Fax:712-642-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42149719OtherCOMMERCIAL & OTHER STATES
IAA004235OtherCHAMPUS
IA39891OtherWELLMARK
IA0485581Medicaid
IA42149719OtherCOMMERCIAL & OTHER STATES
IA4001120005Medicare NSC
IADF3759Medicare PIN