Provider Demographics
NPI:1255590634
Name:SIOUX CITY OPTOMETRIC CENTER, P C
Entity type:Organization
Organization Name:SIOUX CITY OPTOMETRIC CENTER, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-252-4325
Mailing Address - Street 1:600 4TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1750
Mailing Address - Country:US
Mailing Address - Phone:712-252-4325
Mailing Address - Fax:
Practice Address - Street 1:600 4TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1750
Practice Address - Country:US
Practice Address - Phone:712-252-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0090126Medicaid
IA0090126Medicaid
IA0336550001Medicare NSC
IA09012Medicare PIN