Provider Demographics
NPI:1871637736
Name:WOODLAND EYE CLINIC, PC
Entity Type:Organization
Organization Name:WOODLAND EYE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINECKER
Authorized Official - Suffix:
Authorized Official - Credentials:REVCYLE
Authorized Official - Phone:316-247-9771
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-0100
Mailing Address - Country:US
Mailing Address - Phone:563-245-2304
Mailing Address - Fax:563-245-2392
Practice Address - Street 1:606 S RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9339
Practice Address - Country:US
Practice Address - Phone:563-252-3041
Practice Address - Fax:563-252-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty