Provider Demographics
NPI:1821335167
Name:ADVANCED EYECARE ASSOCIATES OF EASTERN IOWA VINTON PC
Entity Type:Organization
Organization Name:ADVANCED EYECARE ASSOCIATES OF EASTERN IOWA VINTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEILBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-472-3848
Mailing Address - Street 1:1113 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349
Mailing Address - Country:US
Mailing Address - Phone:319-472-3848
Mailing Address - Fax:319-472-3192
Practice Address - Street 1:1113 W 3RD ST
Practice Address - Street 2:BOX 397
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349
Practice Address - Country:US
Practice Address - Phone:319-472-3848
Practice Address - Fax:319-472-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA 02350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0760330Medicaid
IAI19254Medicare UPIN