Provider Demographics
NPI:1588622278
Name:ASSOCIATED OPHTHALMOLOGISTS, PC
Entity Type:Organization
Organization Name:ASSOCIATED OPHTHALMOLOGISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VERSACKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-243-1580
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:STE 202
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1414
Mailing Address - Country:US
Mailing Address - Phone:515-243-1580
Mailing Address - Fax:515-243-1442
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:STE 202
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-243-1580
Practice Address - Fax:515-243-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04179OtherBLUE CROSS/BLUE SHIELD
IA0041798Medicaid
IA=========OtherCOMMERCIAL
IA0041798Medicaid
IA=========OtherCOMMERCIAL