Provider Demographics
NPI:1205983897
Name:IOWA EYE PROSTHETICS, INC.
Entity type:Organization
Organization Name:IOWA EYE PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BULGARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:BA, BCO, FASO
Authorized Official - Phone:319-354-3434
Mailing Address - Street 1:625 1ST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2101
Mailing Address - Country:US
Mailing Address - Phone:319-354-3434
Mailing Address - Fax:
Practice Address - Street 1:625 1ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2101
Practice Address - Country:US
Practice Address - Phone:319-354-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL081105-08 CERT#332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA001983OtherCHAMPUS
IA50796OtherBC-BS O & P
IA0128413Medicaid
IA40219IOOtherBC-BS OF MN
IA63648OtherBC-BS OF KS
IA12841OtherBC-BS DME
IA12841OtherBC-BS DME