Provider Demographics
NPI:1891832788
Name:OSCEOLA VISION CENTER P.C.
Entity Type:Organization
Organization Name:OSCEOLA VISION CENTER P.C.
Other - Org Name:OSCEOLA VISION CENTER, CHARITON VISION CENTER, OTTUMWA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-342-2737
Mailing Address - Street 1:131 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1270
Mailing Address - Country:US
Mailing Address - Phone:641-342-2737
Mailing Address - Fax:641-342-4474
Practice Address - Street 1:147 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1218
Practice Address - Country:US
Practice Address - Phone:641-774-7507
Practice Address - Fax:641-774-0466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSCEOLA VISION CENTER P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1933152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7607Medicare ID - Type UnspecifiedGROUP NUMBER
0277610001Medicare NSC