Provider Demographics
NPI:1336362623
Name:LAND EYE CENTER, PLC
Entity Type:Organization
Organization Name:LAND EYE CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:2007-04-11
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22022207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2173906Medicaid
IA2173906Medicaid
IAA01623Medicare UPIN