Provider Demographics
NPI:1245423540
Name:NORTH IOWA EYE CLINIC, P.C.
Entity type:Organization
Organization Name:NORTH IOWA EYE CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:641-423-8861
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1877
Mailing Address - Country:US
Mailing Address - Phone:641-423-8124
Mailing Address - Fax:641-423-0727
Practice Address - Street 1:401 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-9999
Practice Address - Country:US
Practice Address - Phone:641-423-8124
Practice Address - Fax:641-423-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1156330002Medicare NSC