Provider Demographics
NPI:1962453779
Name:OPTOMETRIC ASSOCIATES OF WARREN COUNTY PC
Entity Type:Organization
Organization Name:OPTOMETRIC ASSOCIATES OF WARREN COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINJUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-961-5305
Mailing Address - Street 1:1228 SUNSET DR
Mailing Address - Street 2:STE A
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-2401
Mailing Address - Country:US
Mailing Address - Phone:515-981-0224
Mailing Address - Fax:515-981-5389
Practice Address - Street 1:1228 SUNSET DR
Practice Address - Street 2:STE A
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-2401
Practice Address - Country:US
Practice Address - Phone:515-981-0224
Practice Address - Fax:515-981-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118950Medicaid
IA00284Medicare PIN
IA0118950Medicaid