Provider Demographics
NPI:1568734788
Name:WITTROCK & ECKHART, PLLC
Entity Type:Organization
Organization Name:WITTROCK & ECKHART, PLLC
Other - Org Name:STYLEYES AMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WITTROCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-360-5636
Mailing Address - Street 1:650 S PRAIRIE VIEW DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6686
Mailing Address - Country:US
Mailing Address - Phone:515-225-6447
Mailing Address - Fax:515-226-2347
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6166
Practice Address - Country:US
Practice Address - Phone:515-232-1436
Practice Address - Fax:515-232-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty