Provider Demographics
NPI:1578744256
Name:HALSTED'S PC
Entity Type:Organization
Organization Name:HALSTED'S PC
Other - Org Name:GROETKEN FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GROETKEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-546-8998
Mailing Address - Street 1:16 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3515
Mailing Address - Country:US
Mailing Address - Phone:712-546-8998
Mailing Address - Fax:712-546-8971
Practice Address - Street 1:16 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3515
Practice Address - Country:US
Practice Address - Phone:712-454-6899
Practice Address - Fax:712-546-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28406OtherBCBS OF IOWA
IA1760436802OtherNPI PROVIDER
IA0135230002OtherMEDICARE CIGNA
IA2195669Medicaid
IA11206OtherMIDLANDS
IA0135230002OtherMEDICARE CIGNA
IA1760436802OtherNPI PROVIDER
IA2195669Medicaid