Provider Demographics
NPI:1619480951
Name:CORALVILLE EYE ASSOCIATES, INC
Entity Type:Organization
Organization Name:CORALVILLE EYE ASSOCIATES, INC
Other - Org Name:PEARLE VISION CORALVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-466-0644
Mailing Address - Street 1:2611 JAMES ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1961
Mailing Address - Country:US
Mailing Address - Phone:319-466-0644
Mailing Address - Fax:319-466-0330
Practice Address - Street 1:2611 JAMES ST STE 200
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1961
Practice Address - Country:US
Practice Address - Phone:319-466-0644
Practice Address - Fax:319-466-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty