Provider Demographics
NPI:1932103611
Name:DRIESEN EYE CENTER, P.C.
Entity Type:Organization
Organization Name:DRIESEN EYE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-722-2051
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-0020
Mailing Address - Country:US
Mailing Address - Phone:712-722-2051
Mailing Address - Fax:712-722-4531
Practice Address - Street 1:318 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1852
Practice Address - Country:US
Practice Address - Phone:712-722-2051
Practice Address - Fax:712-722-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44793OtherBC/BS
IA0121871Medicaid
IACG1306OtherRAILROAD MEDICARE
IACG1306OtherRAILROAD MEDICARE
IA0121871Medicaid