Provider Demographics
NPI:1740249978
Name:WOLFE CLINIC EYE CENTERS, LC
Entity type:Organization
Organization Name:WOLFE CLINIC EYE CENTERS, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-240-8721
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1620 SUPERIOR ST
Practice Address - Street 2:UNIT 3
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2913
Practice Address - Country:US
Practice Address - Phone:515-832-2401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOLFE CLINIC EYE CENTERS LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACH5329OtherRAILROAD MEDICARE GROUP
IA1104117Medicaid
IA44714OtherMEDICARE GROUP