Provider Demographics
NPI:1851545800
Name:DR. JEFFREY L. KOENEN, PC
Entity Type:Organization
Organization Name:DR. JEFFREY L. KOENEN, PC
Other - Org Name:801 EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOENEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-244-7393
Mailing Address - Street 1:801 GRAND AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-8010
Mailing Address - Country:US
Mailing Address - Phone:515-244-7393
Mailing Address - Fax:515-244-2343
Practice Address - Street 1:801 GRAND AVE STE 350
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-8010
Practice Address - Country:US
Practice Address - Phone:515-244-7393
Practice Address - Fax:515-244-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA2072261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center