Provider Demographics
NPI:1134344658
Name:LAND EYE CENTER PLC
Entity type:Organization
Organization Name:LAND EYE CENTER PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-242-3937
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0608
Mailing Address - Country:US
Mailing Address - Phone:563-242-3937
Mailing Address - Fax:563-242-3845
Practice Address - Street 1:2315 16TH ST NW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3305
Practice Address - Country:US
Practice Address - Phone:563-242-3937
Practice Address - Fax:563-242-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22022332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA01623Medicare UPIN
IA4314840001Medicare NSC
IA1134344658Medicare PIN