Provider Demographics
NPI:1629188693
Name:FAMILY EYE CENTER
Entity Type:Organization
Organization Name:FAMILY EYE CENTER
Other - Org Name:FAMILY EYE AND CONTACT LENS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-263-7577
Mailing Address - Street 1:315 PARHAM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2604
Mailing Address - Country:US
Mailing Address - Phone:563-263-7577
Mailing Address - Fax:563-263-7814
Practice Address - Street 1:315 PARHAM ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2604
Practice Address - Country:US
Practice Address - Phone:563-263-7577
Practice Address - Fax:563-263-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0189944Medicaid
IA18994OtherBLUE CROSS BLUE SHIELD
IAU06123Medicare UPIN
IA18994OtherBLUE CROSS BLUE SHIELD
IA0517610001Medicare NSC
IAT01370Medicare UPIN
IAV00359Medicare UPIN
IA18994Medicare ID - Type UnspecifiedGROUP
IA410016371Medicare PIN
IA0189944Medicaid