Provider Demographics
NPI:1972662930
Name:ADVANCED EYECARE ASSOCIATES OF EASTERN IOWA PC
Entity Type:Organization
Organization Name:ADVANCED EYECARE ASSOCIATES OF EASTERN IOWA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEROPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZINGULA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-927-3759
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0308
Mailing Address - Country:US
Mailing Address - Phone:563-927-3759
Mailing Address - Fax:563-927-5582
Practice Address - Street 1:105 E BUTLER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-0308
Practice Address - Country:US
Practice Address - Phone:563-927-3759
Practice Address - Fax:563-927-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02350152W00000X
IA02312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28721OtherBCBS
IADF5967OtherGBA/RR MEDICARE
IA0760330Medicaid
IA6296460001Medicare NSC
IA28721OtherBCBS
IAI19280Medicare PIN