Provider Demographics
NPI:1578610796
Name:LOCK FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:LOCK FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-267-1312
Mailing Address - Street 1:101 JORDAN CREEK PKWY
Mailing Address - Street 2:SUITE 12190
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8181
Mailing Address - Country:US
Mailing Address - Phone:515-267-1312
Mailing Address - Fax:
Practice Address - Street 1:101 JORDAN CREEK PKWY
Practice Address - Street 2:SUITE 12190
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8181
Practice Address - Country:US
Practice Address - Phone:515-267-1312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty