Provider Demographics
NPI:1629291992
Name:MICHAEL WADZINSKI, PC
Entity Type:Organization
Organization Name:MICHAEL WADZINSKI, PC
Other - Org Name:WADZINSKI EYE CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:WADZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-226-3937
Mailing Address - Street 1:PO BOX 3564
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-3564
Mailing Address - Country:US
Mailing Address - Phone:712-226-3937
Mailing Address - Fax:712-224-3973
Practice Address - Street 1:2800 PIERCE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3759
Practice Address - Country:US
Practice Address - Phone:712-226-3937
Practice Address - Fax:712-224-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29715207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6022660001Medicare NSC